Nickel is hiring a Health Data Integration Lead — the single owner of every data pipeline that flows into and out of the sovereign on-premise box. Data Integration Lead owns the highest-leverage moat: the ability to ingest, normalize, and reconcile clinical data from an unusually heterogeneous set of sources into a coherent patient longitudinal record that a physician + AI can act on in real time.
The sources are wide and messy:
- EHR extracts — Epic (EpicCare / MyChart / FHIR API), Athenahealth (athenaOne API), plus edge cases (eClinicalWorks, NextGen, Cerner Oracle Health)
- Wearables — Apple HealthKit, Samsung Health SDK, Fitbit Web API, Aura Ring API, Whoop, Garmin, Oura (biometrics, sleep architecture, HRV, activity)
- Lab work — Labcorp, Quest, plus specialty (Function Health, InsideTracker, biomarker panels)
- Advanced imaging — Prenuvo full-body MRI results, DEXA scans, coronary calcium scoring, CGM data
- Ambient / in-clinic — camera capture (skin flush, fatigue, posture signals), ambient voice transcripts from patient-physician appointments
- Human-in-loop feedback — physician overrides, patient responses to recommendations, marketplace referral outcomes
Everything runs on-premise, sub-second local compute, PHI never leaves the practice. That means data pipelines have to be built for edge deployment, not cloud-native comfort. HIPAA-grade compliance and auditability are non-negotiable.
What You'll Own
- Design and own the entire data ingestion architecture — every EHR, wearable, lab, imaging, and ambient data source. Standardize schemas. Reconcile conflicting fields across sources. Handle real-world messiness (missing dates, ambiguous units, contradictory prescriptions across providers)
- Build the longitudinal patient record layer — the coherent object that AI and physicians both read from
- Own eval + accuracy infrastructure for data quality — clinical trust in the AI depends entirely on trust in the data
- HIPAA + PHI compliance across every pipeline. Audit logging, access controls, secure enclave design for the on-prem box
- Partner with the Senior SWE on physician-facing dashboard integration, and with the CTO on architecture decisions
- Vendor + integration relationships — direct technical relationships with Epic, Athena, wearable vendors, lab APIs
Requirements
- 7-12 years of production data engineering experience
- Direct EHR integration experience — has personally shipped production integrations against Epic (FHIR / Epic App Orchard / EpicCare Link), Athena (athenaOne API), Cerner Oracle Health, eClinicalWorks, NextGen, or comparable. This is the single most important filter. Candidates without real EHR experience do not clear the bar
- HL7 v2 + FHIR R4 fluency — has shipped both, understands the differences, handled the edge cases
- HIPAA-grade production shipping — has owned PHI infrastructure in production. Understands minimum-necessary access, audit logging, BAA constraints
- Autonomous builder DNA — For data integration, the equivalent is the engineer who hit an Epic API rate limit, built a smarter queuing layer, then found FHIR was returning inconsistent codes and built a real-time reconciliation engine — and never asked permission to keep going
- Thick skin under pushback
- Mission alignment on longevity / concierge medicine
- 3+ days in-person in SF Bay Area
- Cracked with AI tooling
- Available to start ASAP
Profile Tier 1 — Health Data Interoperability Specialists (Direct Match) Redox — the leading healthcare integration platform. Direct culture and technical match Particle Health — patient data access via HIE / TEFCA networks Epic engineering — specifically the App Orchard / FHIR / EpicCare Link teams; also Epic → startup exits Datavant — health data connectivity, tokenization, PHI de-identification
Tier 2 — Health Data / Interop Adjacent Health Gorilla — clinical data aggregation Kamere — health data integration 1upHealth — FHIR API platform Innovaccer — healthcare data platform Truveta — health data aggregation across health systems
Tier 3 — Comparable Healthcare Data Platforms with Deep Data Layers Commure — clinical infrastructure (Cerner Oracle / General Catalyst spinout) Flatiron Health — oncology real-world data Verily — clinical trials + longitudinal data Komodo Health, Tempus, Flatiron — clinical / claims data Ribbon Health, Turquoise Health — provider + price data platforms Notable Health, Suki, Abridge, Ambience Healthcare — ambient AI health with data integration surface
Tier 4 — Ex-EHR Engineers with Startup Exits Epic senior engineers who left for startups (rare and highly valued) Cerner Oracle Health engineers post-acquisition Athenahealth platform engineers eClinicalWorks, NextGen, allscripts, MEDITECH platform engineers
Tier 5 — Wearable / Consumer Health Data Engineers Whoop, Oura, Levels, Function Health, InsideTracker data platform engineers Apple HealthKit team Samsung Health, Fitbit (now Google Health) data platform engineers Peloton, Ring, Nest hardware-to-cloud data engineers
Tier 6 — Regulated Data Platform Engineers Palantir Foundry FS — regulated data platform engineers with clearance-grade rigor Snowflake FS / Databricks FS verticals — regulated data infrastructure Anduril, Shield AI data infrastructure — clearance-adjacent
Tier 7 — Longevity / Concierge Medicine Vertical Function Health, Superpower, Fount, Marek Health, Life Force, Blueprint (Bryan Johnson), Ezra, Prenuvo — direct longevity vertical Forward, One Medical (Amazon Care), Parsley Health, Galileo, Steady MD — direct-to-consumer medicine data platform engineers
Strong Bonuses
- On-premise or edge deployment of PHI systems
- TEFCA / QHIN / HIE (CommonWell, eHealth Exchange, Carequality) network experience
- HITRUST, SOC 2 Type II, HIPAA audit experience shipped in production
- Personal connection to longevity, healthspan, or family healthcare journey
- Prior founding data engineer / CTO experience at a healthcare startup that grew
- Open-source contributions to FHIR ecosystem (HAPI FHIR, LinuxForHealth, Smile CDR, Firely)
- Physician / clinical background or family in medicine — surprisingly rare and highly valued
- AI voting agents / parallel agent orchestration experience — same bonus as Sr SWE spec, applies here for data eval infra