Software Engineer .Net/AI Developer

About Optivate

Optivate is a leading provider of healthcare technology software solutions purpose-built for ophthalmologists and eye care specialists. The company's solutions, which include EMR, practice management, patient engagement, image management, and RCM and billing services are designed to streamline clinical documentation workflows and improve daily practice efficiencies for eye care professionals.

Position Summary

We're hiring a full-stack .NET engineer who is AI-native - someone who builds production software end to end and who works fluently with modern AI development tooling and agentic workflows.

"AI-native" here means two things, and we care about both:

You build with AI. You use AI-assisted and agentic development tooling (e.g., Cursor, Claude Code, Copilot) as a core part of how you work - including multi-agent workflows where separate agents handle decomposition, architecture, development, QA, and code review. You know how to drive these tools to ship faster without sacrificing quality.

You build AI into products. You're comfortable integrating LLMs and ML capabilities into real applications, and you understand the production and safety constraints that come with doing that in healthcare.

The bulk of this role is full-stack .NET product engineering. A meaningful and growing portion involves designing and shipping AI-powered features across our platform. This is hands-on building role, not a research role - we're looking for someone who has built, integrated, and shipped software that users depend on, and who reaches for AI tooling instinctively to do it well.

You will:

Design and ship AI-driven features across our ophthalmology platform

Work with third-party LLM integrations

Develop custom ML models

Build domain-specific enhancements using clinical data

This is not a research role. We are looking for someone who has built, integrated, evaluated, and deployed AI systems in production environments.

What You’ll Do:

Design, build, and maintain full-stack features across our ophthalmology platform - backend services and APIs in .NET/C# (.NET Core, .NET 10) and responsive frontend interfaces in HTML/CSS

Use AI-native and agentic development workflows (e.g., Cursor multi-agent pipelines for decomposition, architecture, implementation, QA, and review) to move quickly while keeping code clean and reliable

Design and integrate AI-powered features - including third-party LLM integrations - that fit safely into clinical software

Troubleshoot and improve distributed systems

Establish and participate in code review processes

Work within an agile framework, contributing to:

Sprint planning

Daily standups

Retrospectives

Write clean, maintainable, testable code, and establish and participate in code review

Collaborate across product, clinical, and engineering teams

Contribute to architectural decisions, including where and how AI fits into our systems

Work within an agile framework: sprint planning, daily standups, and retrospectives AI Responsibilities

Depending on the work in front of us, you may:

Integrate third-party LLMs (OpenAI, Anthropic, Azure OpenAI, Hugging Face) into production features

Build retrieval pipelines using embeddings and vector databases (Pinecone, FAISS, Weaviate) and implement semantic search

Develop prompt engineering strategies with testing and versioning

Design evaluation approaches that measure accuracy, reliability, hallucination rates, and clinical relevance

Collaborate on deploying, monitoring, and maintaining AI services in production

Optimize AI feature performance, latency, and cost

Required Qualifications:

3–7 years of professional software development experience with strong full-stack delivery

Strong, current experience with .NET/C# (.NET Core and/or .NET 10)

Proficiency building responsive UIs with HTML/CSS

Demonstrated fluency with AI-assisted and agentic development tooling (e.g., Cursor, Claude Code, Copilot), ideally including multi-agent development workflows

Experience integrating LLM APIs into real, shipped systems (does not need to be the bulk of your career - but you've done it and understand the tradeoffs)

Solid foundation in data structures, algorithms, API design, and distributed system design

Experience with at least one major cloud platform (AWS, Azure, or GCP)

Familiarity with model limitations, evaluation tradeoffs, and the realities of running AI in production

Team & Process Experience:

Experience working in collaborative environments with exposure to:

Git version control and branching strategies

Agile methodologies (Scrum/Kanban)

Task/story management tools

Code reviews

Architectural discussions

Cross-functional collaboration

Mindset & Collaboration:

AI-native mindset (data, models, feedback loops, iteration)

Pragmatic builder who understands production constraints

Comfortable with ambiguity in emerging AI spaces

Strong communicator, especially explaining AI tradeoffs

Motivated to apply AI in healthcare where safety and reliability matter

Nice to Have:

Experience with Blazor, particularly Blazor Hybrid and .NET MAUI for building cross-platform applications on a shared .NET codebase

Experience building or fine-tuning ML models (NLP, structured data, computer vision)

Enhancing foundation models with RAG, fine-tuning, embeddings, or adapters

Computer vision experience, especially medical imaging

Experience with clinical or regulated datasets; HIPAA familiarity

MLOps experience: model versioning, experiment tracking, monitoring, CI/CD for ML

Designing AI evaluation benchmarks

Reinforcement learning or simulation experimentation (Gymnasium a plus)

OAuth and systems integration patterns; RESTful API design

Git branching strategies and experience in Scrum/Kanban environments

What We Offer:

A core role building real software that eye care practices depend on every day

The chance to work AI-native - both shipping AI-powered features and using cutting-edge agentic development tooling as part of how we build

Ownership over meaningful initiatives and a voice in architectural decisions

A collaborative team at an exciting inflection point

Professional development opportunities

Challenging, mission-driven problems in healthcare