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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 FFR CT  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 (FFR CT  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 500,000 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,