Head of Engineering - Agentic AI Healthcare SaaS | Zenara Health

*This is not a role with 2070 Health*Role Title: Head of Engineering Location: Remote across India (~6 hours overlap with US Pacific time) Type: Full-time Reports to: Founder-CEO Compensation: Well above market for Indian startups at this level. We pay for the caliber we're hiring.About the CompanyZenara Health builds GenAI-powered clinical decision support and workflow tools for mental health clinics. We integrate AI-driven platforms with professional clinical care to offer personalized and effective mental health solutions — from AI-enhanced evaluations to care coordination — creating a seamless digital experience for both patients and providers.We are an AI-native organization. That's not a marketing label. Our engineering model is fundamentally built around AI agents participating in the software development lifecycle. We are a startup, not a department.About the RolePay close attention here. If you are an engineering manager who primarily conducts standups and writes status reports, this role may not suit you.We are transitioning from the product stage to the commercial stage — multiple products, real customers, sensitive clinical data. Our engineers are already delivering, and now we need cohesive engineering leadership to transform exceptional individual contributions into collective organizational success.What makes this role different from every other Head of Engineering posting: Our engineering team is small by design. A handful of high-caliber engineers orchestrate AI agents that handle significant portions of the SDLC — from code generation to testing to documentation. Your job is not to manage 20 engineers writing code. Your job is to design, implement, and continuously refine the human-agent engineering model — including maker-checker workflows, quality gates for AI-generated output, and escalation protocols that ensure AI speed doesn't come at the cost of AI sloppiness.This is a relatively new way of working. Very few people have deep experience running agentic SDLC at scale. We're not looking for someone who's done this exact job before — we're looking for someone with the raw intellectual horsepower to figure it out. High learning velocity, first-principles thinking, and comfort with ambiguity matter more than years on a resume.You will report directly to the founder-CEO, take ownership of results, and shape the engineering organization. This is the technical co-leader seat — ultimately becoming the person the founder relies on to own all of engineering.What You Will Own (Everything)1. Delivery OutcomesYou will oversee delivery for all products — scope management, release cadence, quality controls, and stakeholder alignment. If something is delayed, it's your responsibility. If a product ships smoothly, you can claim that success. You'll shield engineers from scope changes and give the CEO predictable delivery rather than last-minute heroics.2. Agentic SDLC & AI Governance (The Differentiator)This is the core of what makes this role unique. You will own the design and execution of our agentic software development lifecycle:Human-agent workflow design: Define how AI agents participate in coding, testing, code review, and documentation — and where human engineers must intervene.Maker-checker patterns: Build quality gates that catch AI sloppiness. Every AI-generated artifact needs a human verification step calibrated to the risk level — a UI tweak needs a different checkpoint than a database migration.Agent orchestration: Determine which agents we use, how they're configured, what guardrails they operate within, and how engineers supervise their output.AI tool governance: Define approved tools, IP protection policies, and ensure AI accelerates development without introducing risk — especially given the sensitivity of clinical/PHI data.Continuous refinement: This model is new. You'll measure what's working, what's failing, and iterate. The playbook doesn't exist yet — you'll write it.If you don't have a strong, opinionated perspective on how AI agents should participate in the engineering process — beyond "we use Copilot" — this role is not for you.3. Engineering TeamYou will directly manage the engineering team — hiring, performance, coaching, feedback, conflict resolution, and retention. The team is small and high-leverage; every person matters disproportionately. You'll set the culture and performance bar. Difficult conversations happen early. Engineers will want to work with you because you are fair, direct, and invested in their growth.4. System ArchitectureYou own the architecture across the full stack: web applications, APIs, infrastructure, and AI integrations. You'll make trade-off calls — speed vs. rigor, refactor vs. ship, infrastructure vs. features. You should be capable of reviewing code, debugging production issues, and challenging architectural decisions with substance. In a clinical data environment, architectural choices carry compliance and safety implications — you'll factor