Designs and maintains large-scale distributed systems on Azure using C# and .NET. Owns backend services, APIs, data access, cloud infrastructure, CI/CD, and operational support. Drives architecture and technical strategy, resolves systemic production issues, collaborates with business stakeholders, and mentors engineers. The role requires extensive experience with Azure, production backend systems, complex codebases, distributed systems, and regulated or domain-heavy industries, with preferred healthcare and life sciences expertise.