Heartflow is a medical technology company advancing the diagnosis and management of coronary artery disease, the #1 cause of death worldwide, using cutting-edge technology. The flagship product-an AI-driven, non-invasive cardiac test supported by the ACC/AHA Chest Pain Guidelines called the Heartflow FFRCT Analysis-provides a color-coded, 3D model of a patient's coronary arteries indicating the impact blockages have on blood flow to the heart. Heartflow is the first AI-driven non-invasive integrated heart care solution across the CCTA pathway that helps clinicians identify stenoses in the coronary arteries (RoadMap Analysis), assess coronary blood flow (FFRCT Analysis), and characterize and quantify coronary atherosclerosis (Plaque Analysis). Our pipeline of products is growing and so is our team; join us in helping to revolutionize precision heartcare.
Heartflow is a publicly traded company (HTFL) that has received international recognition for exceptional strides in healthcare innovation, is supported by medical societies around the world, cleared for use in the US, UK, Europe, Japan and Canada, and has been used for more than 750,000 patients worldwide.
As a Staff Application Database Architect, you will be the backend database expert behind the production applications and web services that power Heartflow's clinical and operational platform. This is a hands-on role: the majority of your time will be spent designing OLTP schemas, writing and tuning high-performance queries, and working directly inside our Python/Django services to solve real data access problems - alongside setting the architectural direction for how clinical, imaging, and operational data is structured, accessed, and governed across our AWS-based platform. Exposure to Data Lake, analytics pipelines, or AI-enablement work is a plus.
Job Responsibilities:- Design, Build & Own OLTP Database Systems: Take hands-on ownership of the transactional (OLTP) databases powering Heartflow's clinical and operational applications. Design schemas, write and optimize complex queries, and directly implement performance improvements - indexing, partitioning, connection pooling, caching - for high-throughput, low-latency web services.
- Drive Application Data Access & ORM Strategy: Define and implement best practices for how our Python/Django services interact with the database via the Django ORM. Solve real-world problems like N+1 queries, lazy-loading pitfalls, transaction isolation, connection pool exhaustion, and read/write splitting; review and directly contribute to high-impact schema and query changes in application code.
- Own Database Performance & DBA Excellence: Set direction for database operations - uptime, capacity, backups, recovery, schema evolution, and incident response. Establish SLOs, observability, and runbooks; partner with engineering and SRE teams to keep mission-critical clinical workloads fast, reliable, and secure.
- Lead Transactional Data Modeling: Own conceptual, logical, and physical data models for our operational systems. Drive consistent representation of patients, studies, cases, results, and devices, and steward the master and reference data needed for high-integrity clinical applications.
- Advance the Semantic Structure for AI Agent Context: Contribute to enriching Heartflow's transactional data model with semantics - metadata and controlled vocabularies - so AI agents and downstream consumers can reliably retrieve and reason over clinical and operational information.
- Champion Compliance, Security & Privacy: Ensure data architectures, flows, and access controls strictly adhere to FDA, HIPAA, GDPR, and other applicable standards. Partner with Quality, Regulatory, InfoSec, and Privacy teams to embed compliance into the data lifecycle by design.
- Support the Data Lake & Analytics Handoff (minor, bonus scope): For candidates with the background, partner with IT, Research, and Systems Engineering to ensure OLTP source systems produce clean, well-modeled data that feeds downstream Data Lake and analytics pipelines. This is a supporting responsibility for the right candidate, not a requirement of the role.
- Advance the Semantic Structure for AI Agent Context (minor, bonus scope): For candidates with the background, contribute to enriching Heartflow's transactional data model with semantics - metadata and controlled vocabularies - so AI agents and downstream consumers can reliably retrieve and reason over clinical and operational information.
Skills Needed:You have experience in the following:
- OLTP Database Engineering (Primary): Deep, hands-on expertise in relational databases (PostgreSQL, MySQL, Aurora, or equivalent) supporting production web applications - schema design, query optimization, indexing, partitioning, replication, and HA/DR.
- Application & Web Service Data Access: Strong experience building backend data layers for web applications and services in Python, with expert-level fluency in SQLAlchemy and/or the Django ORM. Deep understanding of connection pooling, caching (Redis/Memcached), transaction management, and common ORM pitfalls at scale.
- Data Modeling: Expert-level conceptual, logical, and physical modeling for transactional/OLTP workloads (3NF or equivalent), including modeling for healthcare/clinical domains.
- Database Engineering & DBA Leadership: Performance tuning, partitioning, indexing strategy, replication, HA/DR, and operational excellence for production relational databases.
- Cloud Platforms: Building data systems in modern cloud ecosystems - AWS preferred (RDS/Aurora, ElastiCache, etc.) - with a strong grasp of cost, security, and reliability tradeoffs at scale.
- Healthcare Data & Compliance: Working with clinical, imaging, or device data under regulatory regimes such as FDA, HIPAA, and GDPR; familiarity with healthcare data standards (e.g., FHIR, HL7, DICOM) is a strong plus.
- Technical Leadership: Mentoring senior engineers, driving cross-team architectural decisions, establishing engineering standards, and influencing technology selection across multiple teams and programs.
Nice to have (bonus, not required):
- Analytics / Data Lake Exposure: Familiarity with Data Lake or lakehouse concepts (e.g., S3, Glue, Spark, Airflow) for the minor analytics-handoff portion of the role.
- AI Enablement & Semantic Data: Exposure to metadata, schema registries, ontologies, or semantic layers that make data usable by AI/agentic systems.
You are passionate about:- Application-Grade Data Systems: Building rock-solid transactional databases that real clinicians and applications depend on every day.
- Engineering Excellence: Championing high-quality data systems, rigorous review and testing practices, and elevating the technical baseline of the team.
- Hands-On Ownership: Staying close to the code and the query plan - you'd rather fix the slow query yourself than just write a standard for it.
- Constructive Collaboration: Fostering open communication across Engineering, IT, Research, and Systems Engineering, and guiding healthy technical debates that result in better outcomes.
Educational Requirements & Work Experience:- Bachelor's degree in Computer Science, Engineering, or a related discipline, or equivalent experience. Master's preferred.
- 10+ years of relevant industry experience as a backend/application database engineer or data architect, with deep, hands-on OLTP experience supporting production web applications or web services. Data warehousing/ETL experience is a plus.
A reasonable estimate of the base salary compensation range is $190,000 to $250,000, plus bonus and equity. #LI-Hybrid
Heartflow is an Equal Opportunity Employer. We are committed to a work environment that supports, inspires, and respects all individuals and do not discriminate against any employee or applicant because of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. This policy applies to every aspect of employment at Heartflow, including recruitment, hiring, training, relocation, promotion, and termination.
Positions posted for Heartflow are not intended for or open to third party recruiters / agencies. Submission of any unsolicited resumes for these positions will be considered to be free referrals.
Heartflow has become aware of a fraud where unknown entities are posing as Heartflow recruiters in an attempt to obtain personal information from individuals as part of our application or job offer process. Before providing any personal information to outside parties, please verify the following: A) all legitimate Heartflow recruiter email addresses end with "@heartflow.com" and B) the position described is found on our careers site at
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