Octagos is modernizing remote cardiac monitoring with AI-powered automation, seamless EHR integrations, and accuracy proven in high-volume, real-world clinics. Atlas AI™ triages cardiac device transmissions to filter nonactionable alerts and highlights the events that need true clinical attention. Through our Two-Brain Approach™ – combining Atlas AI™ with IBHRE-certified oversight – Octagos delivers 99%+ accuracy, sensitivity, and specificity for near-perfect clinical performance. With fast bi-directional EHR integrations, and flexible, cost-effective implementation, Octagos helps clinics scale care efficiently without compromise. Recognized by TIME and Statista as one of the World’s Top HealthTech Companies 2025, Octagos is redefining how cardiac care is delivered.
Role Summary
We are looking for a hands-on Database Administrator to own performance, reliability, and observability for our Azure SQL Server environment. Our database tier spans multiple schemas (production, Power BI reporting, analytics, ETL procedures, audit, support, and watchtower), supports 300+ stored procedures and views, and runs scheduled Azure Elastic Jobs. This role will proactively monitor database health, diagnose regressions, and lead advanced SQL tuning and indexing efforts to keep clinical workflows fast and dependable.
The ideal candidate is not someone who simply keeps the lights on. We need a DBA who designs for query performance from day one, establishes SQL standards that prevent tech debt, and partners with application engineers to keep the full stack (SQL to C# EF to Angular) aligned, performant, and maintainable. You will set the standard for how the team writes, reviews, and optimizes SQL, with a strong focus on database health monitoring and advanced performance tuning.
This is an In-Office position based in Houston, Texas.
Key Responsibilities
Data Architecture and Modernization
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Drive data architecture improvements (table decomposition, normalization) across core entities (Clinic, Patient, Device, Transmission).
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Rationalize andoptimizeviews: remove redundancy, flatten view-on-view chains, and improve optimizer effectiveness.
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Design read/write separation strategies, including Redis caching for high-read, low-write data (settings, lookups, device metadata).
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Optimizeanalytics/ETL stored procedures and Azure Elastic Jobs that drive reporting.
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Conduct proof-of-concept testing for schema changes (e.g., extension tables vs. EAV patterns) and present data-driven recommendations to engineering leadership with migration paths and rollback plans.
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Manage schema evolution usingDbUpmigrations, ensuring backward compatibility, zero-downtime deployments, and a documented blast-radius assessment for every migration that touches dependent stored procedures, views, Entity Framework models/mappings, and Angular interfaces.
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Maintain a living data dictionary and entity relationship documentation covering all schemas (dbo,pbi, analytics, audit, support, watchtower), key tables, column-level lineage, and cross-schema dependencies.
Performance Tuning and Query Optimization
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Lead continuous performance tuning and database health monitoring– Identify and resolve slow queries, blocking, deadlocks, and resource bottlenecks before they impact clinical operations.
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Analyze execution plans, leverage Query Store for regression detection, and maintain index health (rebuild/reorganize schedules, statistics freshness) across high-volume tables including Transmission,Transmission Status Map, Patient, and Patient Device Information.
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Develop and maintain an index strategy covering clustered, non-clustered, filtered, and covering indexes. Evaluate indexed views for high-read-frequency reporting views. Track index usage stats and remove unused indexes that add write overhead.
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Partner with .NET engineers to optimize Entity Framework (EF) data access patterns: review generated SQL,eliminateN+1 query patterns, tune projections and includes, and ensure parameterization/type alignment to preserve index seeks.
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Optimize Hangfire job-related queries and the analytics ETL pipeline to ensure scheduled jobs complete within their time windows without competing for resources with real-time portal queries.
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Enforces argable query patterns by identifying and refactoring anti-patterns such as functions on indexed columns in WHERE clauses, cursors used for row-by-row processing, SELECT * in stored procedures, and NOLOCK hints applied without DBA approval.
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Own tempdb contention management: identify procedures creating excessive temp table churn, recommend CTE or table variable alternatives for small datasets, and monitor tempdb allocation wait stats.
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Run periodic performance reviews (top queries, waits, plan regressions/parameter sniffing) and deliver actionable remediation plans.
Standards, Best Practices and Governance
Define and enforce stored procedure standards across the engineering team: SET NOCOUNT ON, SET XACT_ABORT ON with transactions, TRY/CATCH error handling, proper parameterization, pagination with OFFSET/FETCH or keyset, and the standards naming convention.
Author and maintain a SQL development style guide covering naming conventions for all object types (stored procedures, views, functions, indexes, schemas), parameter design, error handling patterns, transaction scoping rules, and comment/documentation requirements.
Enforce standard active-record filters across all data-access objects and build automated checks to detect missing filters in new or modified stored procedures.
Establish code review standards for all SQL changes: require execution plan review for any query touching high-volume tables, mandate index impact assessment for schema migrations, and enforce consistent use of time zone conversion patterns (AT TIME ZONE) for SessionDate display.
Implement anti-pattern detection as part of the CI/CD pipeline or periodic audit: flag cursors, SELECT *, missing SET NOCOUNT ON, string-concatenated dynamic SQL, functions on indexed columns in WHERE clauses, and transactions wrapping read-only queries.
Enforce cross-layer data structure alignment: SQL column types/nullability must match C# DTO/entity properties, EF mappings must stay in sync with schema changes, and enum/lookup table values must remain synchronized across SQL, C#, and Angular.
Govern the analytics schema pattern, create and maintain stored procedure and view templates that the engineering team can use as starting points, ensuring every new database object follows established patterns from day one.
Database Operations and Reliability
Administer and monitor MySQL and Azure SQL databases across development, staging, and production environments, ensuring 99.9%+ uptime for a platform that processes cardiac device transmissions around the clock.
Manage capacity planning, elastic pool sizing, and Azure SQL tier optimization, balancing performance against cost as clinic onboarding accelerates.
Own backup and restore strategies, point-in-time recovery testing, and disaster recovery runbook maintenance for databases containing PHI.
Monitor and triage performance alerts using Azure Monitor, Application Insights, and custom OpenTelemetry telemetry dashboards.
Coordinate maintenance windows for index rebuilds, statistics updates, and schema migrations with zero downtime to clinical operations.
Security, Compliance, and Access Control
Implement and enforce HIPAA-compliant data access controls, auditing, and encryption (TDE, Always Encrypted where applicable) across all schemas.
Manage database-level permissions, row-level security, and service account credentials in alignment with SOC 2 Type II requirements.
Ensure PHI never appears in stored procedure PRINT/RAISERROR messages, dynamic SQL trace outputs, plan cache, error messages, or URL parameters.
Participate in security audits, vulnerability remediation, and PHI exposure assessments at the database tier.
Security Data Quality and Observability
Execute and extend the data quality playbook including automated SQL checks, KPIs, and remediation runbooks that monitor data integrity across the Clinic, Patient, Device, Transmission hierarchy.
Build and maintain database health dashboards covering query performance, wait statistics, DTU/vCore utilization, job success rates, tempdb contention, and blocking/deadlock trends.
Instrument custom telemetry events at the database layer integrated with the platform’s OpenTelemetry and Application Insights observability stack.
Collaboration and Documentation
Serve as the database subject-matter expert across the engineering organization, supporting US (Houston) and India development teams.
Contribute to architecture decision records (ADRs) for database-impacting changes, including schema migrations, index strategies, and caching layer design.
Document database objects, data flows, schema dependencies, stored procedure inventories, and operational runbooks in the team wiki (Azure DevOps Wiki / GitHub Wiki).
Participate in sprint ceremonies, root-cause analysis (RCA) reviews, and cross-functional working sessions with application engineers, QA, and the data team.
Required Qualifications
10+ years of experience as a DBA or Senior DBA, with at least 2 years managing Azure SQL Database or Azure SQL Managed Instance in a production SaaS environment.
Proven track record of designing and evolving data architectures: table decomposition, schema normalization, denormalization strategies for reporting, and migration planning across hundreds of dependent database objects.
Deep expertise in T-SQL performance tuning: execution plans, index strategies (clustered, non-clustered, filtered, covering, indexed views), wait statistics, Query Store, parameter sniffing diagnosis, and Resource Governor.
Strong experience with stored procedure development following structured patterns (SET NOCOUNT ON, TRY/CATCH, parameterized queries, pagination with OFFSET/FETCH or keyset) and the ability to establish and enforce these standards across a team.
Ability to optimize complex views with 10 to 15+ joins, diagnose nested view performance degradation, flatten view-on-view chains, and recommend indexed view strategies for high-read workloads.
Experience authoring SQL development standards, style guides, and review checklists that are adopted by application engineering teams.
Hands-on experience with Azure database services: elastic pools, geo-replication, automated backups, threat detection, auditing, and cost optimization.
Solid understanding of HIPAA technical safeguards, encryption requirements, and audit logging for healthcare data at the database tier.
Experience with CI/CD-based schema migrations (DbUp, Flyway, or similar) and the discipline to assess blast radius across dependent stored procedures, views, and application-layer DTOs before every migration.
Experience partnering with .NET engineers using Entity Framework (EF) in production systems, including understanding how LINQ patterns translate to SQL and how to avoid common performance pitfalls (N+1 queries, over-fetching, missing indexes).
Strong written and verbal communication skills; comfortable collaborating with a distributed engineering team across US and India time zones and presenting architecture recommendations to engineering leadership.
Preferred Qualifications
Experience in healthcare SaaS, particularly with cardiac remote monitoring, medical devices, or clinical data workflows involving PHI.
Experience leading data architecture modernization projects: table decomposition, schema refactoring, ETL pipeline redesign, or data warehouse/reporting layer buildout.
Track record of authoring and enforcing SQL development standards across a multi-team engineering organization.
Familiarity with Power BI Embedded and writing DAX-optimized SQL views including CTE latest-run consumption patterns.
Exposure to Hangfire or similar job scheduling frameworks and their database footprint (table locks, cleanup, dashboard queries).
Experience administering databases that support RPA/automation workflows with high-frequency insert/update patterns.
Azure certifications (AZ-900, DP-300, or AZ-500) are a plus.
Experience with SOC 2 Type II audit preparation and evidence collection at the database tier.
Technology Environment
Azure SQL Server (dbo, pbi, analytics, audit, support, watchtower schemas), SSMS, Azure Data Studio
.NET 8 / C# with Entity Framework (EF), ASP.NET Core Web API
Analytics, ETL patterns, Power BI Embedded
Azure Monitor, Application Insights, OpenTelemetry, custom dashboards
Auth0 with role-based access control, clinic-level data isolation
Compensation and Benefits
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Paid Time Off
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Health, dental, and vision insurance
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Competitive salary commensurate with experience
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Opportunity to shape a critical function at a growing healthcare technology company
