Senior Database Reliability Engineer

Job Title: Senior Database Reliability Engineer

Company Overview

Prompt Health is revolutionizing healthcare by delivering highly automated and modern B2B enterprise software to rehab therapy businesses, the teams within, and the patients they serve. We have established ourselves as the go-to platform in the space, are setting a new standard in healthcare technology, and rapidly growing our market share.

We're constantly identifying new challenges across outpatient therapy and the broader healthcare space. As a Senior Database Reliability Engineer at Prompt, you'll own the health, performance, and cost-efficiency of the databases that power our EMR (electronic medical record) and every product and team built on top of it. This is a role for someone who doesn't just respond to alerts, but gets to the root of problems, prevents them from recurring, and shapes the architecture so the platform scales cleanly as we grow.

If you're a database expert who thinks in query plans, replication topologies, and dollars-per-workload, we want you on our team!

Why work for Prompt?

Big Challenges:

Here at Prompt, we are solving complex and unique problems that have plagued the healthcare industry since the dawn of time.

Talented People:

Prompt didn't happen by chance, it's a team of incredibly talented and proven individuals who all made their mark before joining forces to build the greatest software on the planet for rehab therapists.

Healthy Approach:

This isn't an investment bank. At Prompt you own your workload and the entire organization takes a liking to smart work (over hard work).

Positive Impact:

Prompt helps outpatient rehab organizations treat more patients and deliver better care with less environmental waste. That means less surgery and less narcotic-based pain treatment, all while turning a paper-heavy industry digital.

Key Responsibilities

• Own the reliability, performance, and availability of all production databases (Aurora MySQL on AWS) across our EHR, Data, and AI teams.
• Manage database alerting end to end – build and maintain the observability pipeline that feeds database metrics and alerts into Datadog, and fold after-hours database alerts into the DevOps on-call rotation.
• Educate and train the various engineering teams about proper database hygiene and best-performing queries
• Implement automated safeguards, including automatic termination of long-running and runaway queries, and fast, always-available visibility into what's currently executing on any instance.
• Author and maintain database runbooks so that first responders can act on incidents quickly and consistently.
• Dive deep into problematic queries – diagnose, optimize, and re-index – and drive down both latency and the load that forces us to scale out.
• Review new EMR and application queries before release, acting as the performance gate that keeps inefficient queries out of production.
• Architect and continuously right-size our Aurora reader topology and read-routing strategy, matching capacity to real workload and eliminating over-provisioning.
• Own database cost efficiency: instance right-sizing, reserved-capacity/Savings Plan strategy, and storage tiering.
• Manage replication health, backups, restore testing, failover, and disaster recovery.
• Establish safe schema-change and migration practices across teams.
• Partner with the Platform Architect to determine the best path forward for new and existing database workloads
• Handle protected health information (PHI) responsibly within a HIPAA-compliant environment.

Qualifications

• 6+ years in database reliability engineering, database administration, or database engineering, including ownership of production systems at scale.
• Deep MySQL expertise — query optimization, execution-plan analysis, indexing strategy, and replication. Aurora MySQL experience strongly preferred.
• Hands-on experience operating large, multi-reader Aurora or RDS clusters at terabyte scale, including read-routing and connection management.
• Strong command of database observability tooling (Datadog, Percona Monitoring and Management (PMM), Performance Insights, Prometheus/Grafana).
• Proficiency in a scripting language (Python, Bash, or similar) for automation, and comfort with infrastructure-as-code (Terraform).
• Solid AWS operational depth around RDS/Aurora, including cost optimization (instance sizing, reserved capacity, storage types).
• Experience with on-call/incident response and authoring runbooks.
• Excellent communication skills and the ability to collaborate across engineering teams.
• Preferred Skills
• Experience standing up or operating a cloud data warehouse (Snowflake, Databricks, Redshift) and moving analytical workloads off OLTP databases.
• Experience in a HIPAA-regulated or other compliance-heavy environment handling sensitive data.
• Familiarity with query auto-remediation tooling (pt-kill / Percona Toolkit, statement timeouts, custom killers).
• Application-side familiarity (PHP) to collaborate effectively on query review.
• Knowledge of security best practices for database and cloud environments.
• Previous experience with agile methodologies and working in fast-paced environments.