Senior IT Systems Engineer

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, t...

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 wo...

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,...

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.
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. 
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

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
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

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.
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.