Senior IT Systems Engineer

Location: New York City, New York What you’ll be part of Garner is on a mission to transform the U.S. healthcare system — and we’re the only proven player doing exactly that. We partner with employers to redesign how healthcare works: applying 550+ proprietary clinical metrics across 80+ specialties to a dataset of 320M+ patients to identify the best-performing doctors, then using compelling incentives to steer members to the care that helps them get healthier, faster. The result is a rare “win win” — better care and lower costs for both members and employers. In just five years, our work has helped over 2.5 million people access higher-quality care and saved $1B in healthcare costs. We recently raised our Series E and have doubled five years running. If you've ever wanted your work to solve a problem that touches every person in this country, this is the opportunity to do exactly that. You'd be joining a team fundamentally reimagining healthcare in the U.S. — and using AI to scale that impact further and faster than anyone else can. About the role: We are looking for an engineer who can walk into messy, cross-functional workflows and turn them into clean, automated systems that scale. This role focuses on identifying high-friction operational processes across the company and replacing them with durable, API-driven automation. You will work across IT, Security, Engineering, and Business teams to reduce manual work, improve reliability, and build systems that scale with the company. This is not a ticket-driven IT role. You will operate with a high degree of ownership, driving initiatives end-to-end from problem discovery through implementation and rollout. You will be part of the Business Technology - Corporate Engineering team and report to the Director of Business Technology. Where you will work: This role will be based in our New York City office (in the Financial District). You must be willing to work in the office 3 days per week on Tuesday, Wednesday and Thursday. What you will do: Identify and automate high-impact operational workflows across onboarding, offboarding, access management, and service delivery Replace manual, fragmented processes with scalable, API-driven systems Build and maintain integrations across HRIS, identity providers, SaaS platforms, and cloud environments Develop internal tools and automation using platforms like Retool, Okta Workflows, and custom scripts or services Apply infrastructure-as-code to manage and version system configurations Incorporate AI into workflows to improve efficiency in areas like ticket routing, knowledge retrieval, and decision support Design and automate access and security workflows that enforce least-privilege and auditability Own and drive cross-functional initiatives end-to-end, from problem definition through implementation and rollout The ideal candidate has: 4–7+ years of experience in IT, platform engineering, automation, or similar roles Strong scripting or programming ability in Python, Go, Node.js, PowerShell, or similar Experience building API-driven automation across multiple systems Ability to design and implement workflows that span multiple tools and teams Experience with infrastructure-as-code such as Terraform or similar A desire to be a part of a high-performing, mission-driven team that operates with intense urgency, a strong sense of individual accountability, and a commitment to authentic feedback What will make you stand out: Hands-on experience with identity and access systems (Okta, SSO, SCIM, RBAC), including implementation and ongoing management Proven ability to build and scale internal tools using platforms like Retool or other low-/no-code solutions Familiarity with security automation and orchestration (e.g., Tines), with an eye toward reducing manual effort and risk Practical experience leveraging AI/LLMs to streamline and enhance operational workflows Strong understanding of compliance and security standards (HIPAA, SOC 2, HITRUST) and how they shape systems and processes Focused on driving meaningful outcomes Able to identify root-cause, system-level issues and design durable solutions rather than quick fixes Comfortable navigating cross-functional environments with competing priorities and constraints Operates with urgency while building scalable, maintainable solutions Defaults to automation and efficiency wherever possible What you’ll get here You’ll work on problems that matter, at a company working to change healthcare at scale. You’ll work at the intersection of AI and systemic healthcare reform, where the problems we solve are as interesting and compelling as the mission. At Garner, you’ll take on real, ambitious problems with real ownership and autonomy, alongside exceptional, principles-based people who genuinely want you to win. It’s demanding by design. You’ll be challenged to stretch beyond what you thought possible and receive consistent coaching to help you grow and do the best work of your career. This isn't the right fit for everyone, and that's intentional. The people here are driven by what's at stake for real people, and that's what gives our intensity its purpose. Technologies we use: Okta, Okta Workflows, Retool, FreshService (ITSM), Google Workspace, Slack, Atlassian (Confluence and Jira), MDM platforms (Jamf Pro, Kandji/Iru, Intune), Airtable, AWS and GCP, Terraform, Rippling (HRIS), SOAR (Tines), and AI-enabled operational tooling (Claude, Gemini, OpenAI) This is a unique opportunity to join a fast-growing company in a transformative role, helping shape the future of healthcare. Please note: we are unable to sponsor or take over sponsorship of an employment visa at this time. Compensation Transparency: The target salary range for this position is $189,000 - $220,000. Individual compensation for this role will depend on various factors, including qualifications, skills, and applicable laws. In addition to base compensation, this role is eligible to participate in our equity incentive and competitive benefits plans, including but not limited to: flexible PTO, Medical/Dental/Vision plan options, 401(k), Teladoc Health and more. Fraud and Security Notice: Please be aware of recent job scam attempts. Our recruiters use getgarner.com and garnerhealth.com email domains exclusively. If you have been contacted by someone claiming to be a Garner recruiter or a hiring manager from a different domain about a potential job, please report it to law enforcement here and to candidateprotection@garnerhealth.com . Equal Employment Opportunity: Garner Health is proud to be an Equal Employment Opportunity employer and values diversity in the workplace. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, reproductive health decisions, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, genetic information, political views or activity, or other applicable legally protected characteristics. Garner Health is committed to providing accommodations for qualified individuals with disabilities in our recruiting process. If you need assistance or an accommodation due to a disability, you may contact us at talent@garnerhealth.com .