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Cleveland Clinic Software Engineer Interview Guide

Cleveland Clinic Software Engineer interview guide: reported rounds, questions and how candidates describe the process.

The 60-second brief

As a Software Engineer at Cleveland Clinic, you play a pivotal role in developing innovative software solutions that enhance patient care and operational efficiency. Your work directly impacts the clinic's ability to deliver high-quality healthcare services, making it a critical position within the organization. You will collaborate with multidisciplinary teams to design, implement, and maintain applications that support healthcare providers and improve patient outcomes. The scope of your work will not only involve coding and system design but also engaging in high-level discussions about software architecture and the integration of various technological solutions. Given the complexity of healthcare systems, your contributions will be vital in ensuring that software applications are not only functional but also scalable and secure.

This guide is scoped to a Software Engineer candidate at Cleveland Clinic.

Focus areas

  • System Architecture / Architecture Questions
  • MATLAB
  • Technical Interview Preparation (Architecture-Centric)

The Cleveland Clinic interview process

Cleveland Clinic candidates report 4 rounds over 3-5 weeks. The stages below are what candidates describe, not a published process.

Phone Screen

Initial call that may involve a recruiter to discuss your background and role fit.

What to demonstrate

  • Initial call that may involve a recruiter to discuss your background and role fit
  • Depth in System Architecture / Architecture Questions

How to prepare

  • Be able to walk your CV end to end in two minutes, and say why this company specifically.
  • Have your salary expectations, notice period and location constraints ready, and ask for the rest of the loop in writing.

Technical Interview

Interview with the hiring manager focusing on technical questions and behavioral discussions.

What to demonstrate

  • Interview with the hiring manager focusing on technical questions and behavioral discussions
  • Depth in System Architecture / Architecture Questions

How to prepare

  • Answer aloud and timed: What programming languages are you most proficient in, and how have you applied them in previous projects?
  • Answer aloud and timed: Describe a challenging technical problem you faced and how you resolved it.

In-Depth Interview

Engagement with multiple team members discussing past projects and technical challenges.

What to demonstrate

  • Engagement with multiple team members discussing past projects and technical challenges
  • Depth in System Architecture / Architecture Questions

How to prepare

  • Answer aloud and timed: How do you approach debugging and performance optimization in your code?
  • Answer aloud and timed: How would you design a scalable application to manage patient records?

Coding Assessment

Evaluation of problem-solving skills through coding tasks or system design questions.

What to demonstrate

  • Evaluation of problem-solving skills through coding tasks or system design questions
  • Depth in System Architecture / Architecture Questions

How to prepare

  • Answer aloud and timed: What considerations would you take into account when designing a healthcare application for multiple user roles?
  • Answer aloud and timed: Explain the importance of API design in a healthcare system and how you would approach it.

Where candidates lose points

Research the Organization

Understanding Cleveland Clinic's mission and values will help you align your responses during the interview.

Practice Behavioral Questions

Be ready to discuss your past experiences using the STAR (Situation, Task, Action, Result) method to structure your answers.

Prepare for Technical Assessments

Brush up on coding challenges and system design principles relevant to healthcare applications.

Ask Questions

Prepare thoughtful questions for your interviewers to demonstrate your interest in the role and the organization.

Questions & practice

Solve a coding challenge on basic data structures (e.g., arrays, linked lists).

Medium · Coding / Algorithms

Approach

  1. Restate the input: its shape, its size, and what is guaranteed about it.
  2. Name the brute-force solution and its complexity before improving on it.
  3. Choose the data structure from the access pattern, not from familiarity.
  4. State the target complexity and say which constraint rules the naive version out.

Follow-up

  • How does this change if the input no longer fits in memory?
  • What is the worst case, and how likely is it on real data?

Explain the time complexity of different algorithms and when you would use them.

Medium · Coding / Algorithms

Approach

  1. Restate the input: its shape, its size, and what is guaranteed about it.
  2. Name the brute-force solution and its complexity before improving on it.
  3. Choose the data structure from the access pattern, not from familiarity.
  4. State the target complexity and say which constraint rules the naive version out.

Follow-up

  • How does this change if the input no longer fits in memory?
  • What is the worst case, and how likely is it on real data?

Find overlapping job attempts and peak concurrency from lease records

Medium · sweep line · intervals · leases

A day of job_run history yields about 50,000,000 attempt records: (job_run_id, job_type, attempt, started_at, finished_at which is NULL when the worker died, lease_expires_at). Leases expire on a clock, so a job that outran its lease ran twice. Produce (a) every job_run_id whose attempts overlapped in wall-clock time and (b) the peak number of simultaneously running attempts per job_type with the minute it occurred. Target O(n log n). State how you treat a NULL finished_at and what clock skew does to your answer.

Approach

  1. Define the interval before sorting anything: an attempt occupies [started_at, COALESCE(finished_at, lease_expires_at)). finished_at is observed and lease_expires_at is only a promise, so every attempt without a finish contributes an estimate and the whole result is a lower bound on overlap rather than an exact count.
  2. For peak concurrency, sweep: emit 2n endpoints, sort by (timestamp, kind) with ends ordered before starts at equal timestamps, then walk the sequence maintaining a counter per job_type and record each type's maximum with its timestamp. O(n log n) dominated by the sort, O(n) space, or O(1) extra if the sort is external and the walk streams.
  3. For overlap detection, do not compare attempts pairwise. A single global sort by (job_run_id, started_at) gives both the grouping and the order; within a group, keep the maximum end seen so far and report an overlap exactly when the next start is less than that running maximum, which is one linear pass after the sort.
  4. Half-open intervals matter and are easy to get wrong: with closed intervals an attempt ending at the same millisecond another begins reads as concurrency two, and across 50,000,000 records that artefact swamps the real signal.

Follow-up

  • A handler is not idempotent and you have found 400 overlapping jobs. Which of them actually caused damage, and what would you query to find out?
  • Peak concurrency for one job_type is 4 against a configured cap of 4. Is the cap working, or is the data hiding attempts that never started?

Replace offset paging on the resource feed with keyset

Easy · keyset pagination · composite index · sort order

resource holds resource_id, tenant_id, owner_user_id, title, body_ref, version, status ('draft','active','archived','deleted'), created_at, updated_at, deleted_at, with an index on (tenant_id, status, updated_at DESC, resource_id DESC). The listing endpoint returns active resources for one tenant, newest update first, 50 per page, today with LIMIT 50 OFFSET n. Tenants reach page 400 and rows are created while they read. Write the keyset query, define what the cursor carries and how it is encoded, and say which part of the index each predicate uses. Assume PostgreSQL 16.

Approach

  1. Name the two failures separately. OFFSET 20000 makes the server produce and discard 20,000 rows, so page cost grows with depth rather than with page size. Independently, any write that changes how many rows sort above the offset moves the window between two fetches, and the direction decides which anomaly you get: an insert lands at the head of updated_at DESC and pushes already-returned rows down past the boundary, so they are returned a second time; a delete above the offset, or a row whose updated_at is bumped above the cursor, pulls rows up and one is never returned at all. Nothing in the response reveals either.
  2. Write the seek: WHERE tenant_id = $1 AND status = 'active' AND (updated_at, resource_id) < ($2, $3) ORDER BY updated_at DESC, resource_id DESC LIMIT 50. The row-value comparison is one index range rather than a disjunction, and both columns are NOT NULL, which is what makes that comparison well defined.
  3. Map each predicate onto the index: tenant_id and status are equality on the leading columns, (updated_at, resource_id) is the range, and the ORDER BY matches the index order so no Sort node appears and the scan stops after 50 rows. The DESC in the definition only matters for mixed directions — a plain ascending btree on the same columns is read backwards for this query.
  4. Put both sort columns in the cursor and nothing the client can tamper with into another tenant: base64 of (updated_at, resource_id), validated server-side, with tenant_id taken from the principal.

Follow-up

  • The client asks for 'jump to page 400'. What do you offer instead, and what does the honest version cost?
  • Sort order becomes user-selectable across four columns. How many indexes is that, and which would you refuse to add?

Find version gaps and relay lag with window functions

Medium · window functions · event tables · frame semantics

outbox_event holds event_id, aggregate_type, aggregate_id, aggregate_version, event_type, payload, status ('pending','published','dead'), attempts, created_at, published_at. A projection is missing rows and you must decide whether the relay skipped events or the consumer dropped them. Write three queries over the last seven days: one listing every aggregate_id whose published aggregate_version sequence has a hole, one giving per-day counts with a running total, and one returning the newest published event per aggregate. For each, say where the window function is evaluated relative to WHERE and LIMIT. PostgreSQL 16.

Approach

  1. Gaps: compute lead(aggregate_version) OVER (PARTITION BY aggregate_id ORDER BY aggregate_version) in a subquery, then filter next_version <> aggregate_version + 1 in the outer query. Window functions are evaluated after WHERE, GROUP BY and HAVING and before the outer ORDER BY and LIMIT, so the predicate cannot sit in the same WHERE clause and PostgreSQL 16 has no QUALIFY.
  2. Say what the seven-day filter does to the answer: it truncates every partition, so the first row per aggregate has no predecessor inside the window and a hole spanning the boundary is invisible. Widen the window, or join to resource.version as the authority for the true maximum.
  3. Running total: SELECT date_trunc('day', created_at) AS d, count() AS n, sum(count()) OVER (ORDER BY date_trunc('day', created_at) ROWS UNBOUNDED PRECEDING). An aggregate inside a window call is legal because grouping runs before windowing. The grouping key is unique per row here so ROWS and RANGE agree, but write the frame anyway — over ungrouped rows with tied timestamps the default RANGE frame pulls in every peer row and the total jumps.
  4. Newest per aggregate: DISTINCT ON (aggregate_id) ... ORDER BY aggregate_id, aggregate_version DESC is the cheap PostgreSQL-only form when an index matches that order; row_number() OVER (PARTITION BY aggregate_id ORDER BY aggregate_version DESC) = 1 is the portable form and needs a subquery for the same evaluation-order reason as the gap query.

Follow-up

  • Relay failover redelivers events. Does a duplicate break the gap query, and how would you detect one from this table alone?
  • Turn the gap check into a continuous monitor rather than a query someone runs after an incident. What does it watch?

How do you ensure the security of software applications in a healthcare context?

Medium · Technical / Domain Questions

Approach

  1. Clarify what is being asked and what a complete answer contains.
  2. State your assumptions explicitly before working the problem.
  3. Say what you would check first and why it is the highest-information step.
  4. Work from the requirement backwards to the design.

Follow-up

  • What assumption would you test first?
  • How would you know your answer was wrong?

What programming languages are you most proficient in, and how have you applied them in previous projects?

Medium · Technical / Domain Questions

Approach

  1. Clarify what is being asked and what a complete answer contains.
  2. State your assumptions explicitly before working the problem.
  3. Say what you would check first and why it is the highest-information step.
  4. Work from the requirement backwards to the design.

Follow-up

  • What assumption would you test first?
  • How would you know your answer was wrong?

Describe a challenging technical problem you faced and how you resolved it.

Medium · Technical / Domain Questions

Approach

  1. Clarify what is being asked and what a complete answer contains.
  2. State your assumptions explicitly before working the problem.
  3. Say what you would check first and why it is the highest-information step.
  4. Work from the requirement backwards to the design.

Follow-up

  • What assumption would you test first?
  • How would you know your answer was wrong?

How would you design a scalable application to manage patient records?

Medium · System Design / Architecture

Approach

  1. Fix the scope first: who calls this, how often, and what they do when it fails.
  2. Name the read and write paths separately; they rarely have the same bottleneck.
  3. Choose a partition key and say what query it makes expensive.
  4. State the consistency you need, and where you are willing to be stale.

Follow-up

  • What breaks first when traffic grows ten times?
  • How does this behave when that dependency is down for an hour?

What considerations would you take into account when designing a healthcare application for multiple user role

Medium · System Design / Architecture

What considerations would you take into account when designing a healthcare application for multiple user roles?

Approach

  1. Fix the scope first: who calls this, how often, and what they do when it fails.
  2. Name the read and write paths separately; they rarely have the same bottleneck.
  3. Choose a partition key and say what query it makes expensive.
  4. State the consistency you need, and where you are willing to be stale.

Follow-up

  • What breaks first when traffic grows ten times?
  • How does this behave when that dependency is down for an hour?

Explain the importance of API design in a healthcare system and how you would approach it.

Medium · System Design / Architecture

Approach

  1. Say who the caller is and what they do when the call fails halfway.
  2. Define the identity of a request so a retry cannot double-apply it.
  3. Separate accepted, pending, failed and confirmed; they are different facts.
  4. Design the error taxonomy before the success shape; callers branch on it.

Follow-up

  • What happens if the caller retries after a timeout?
  • How does a client discover it is on an old version of this contract?

Discuss a project where you had to integrate multiple systems or platforms.

Medium · System Design / Architecture

Approach

  1. Say who the caller is and what they do when the call fails halfway.
  2. Define the identity of a request so a retry cannot double-apply it.
  3. Separate accepted, pending, failed and confirmed; they are different facts.
  4. Design the error taxonomy before the success shape; callers branch on it.

Follow-up

  • What happens if the caller retries after a timeout?
  • How does a client discover it is on an old version of this contract?

If you were tasked with reducing the loading time of a critical healthcare application, how would you approach

Medium · Problem-solving / Case Studies

If you were tasked with reducing the loading time of a critical healthcare application, how would you approach this?

Approach

  1. Clarify what is being asked and what a complete answer contains.
  2. State your assumptions explicitly before working the problem.
  3. Say what you would check first and why it is the highest-information step.
  4. Work from the requirement backwards to the design.

Follow-up

  • What assumption would you test first?
  • How would you know your answer was wrong?

How would you prioritize features for a new software release based on user feedback?

Medium · Problem-solving / Case Studies

Approach

  1. Clarify what is being asked and what a complete answer contains.
  2. State your assumptions explicitly before working the problem.
  3. Say what you would check first and why it is the highest-information step.
  4. Work from the requirement backwards to the design.

Follow-up

  • What assumption would you test first?
  • How would you know your answer was wrong?

How do you approach debugging and performance optimization in your code?

Medium · Technical / Domain Questions

Approach

  1. Establish what changed and when, before forming any theory.
  2. Pick a bisection that eliminates candidates whichever way it turns out.
  3. Check the instrumentation before believing the symptom.
  4. Separate the trigger from the cause; the deploy is rarely the bug.

Follow-up

  • What would you look at first, and what would it rule out?
  • How would you tell a cause from a coincidence here?

Suggested practice checklist

Built from the rounds and topics Cleveland Clinic candidates report.

Day 1 — Map the Cleveland Clinic loop

  • Write out the reported sequence: Phone Screen, Technical Interview, In-Depth Interview, Coding Assessment.
  • For each round, write one sentence on what it is judging, from the description above, and mark the one you are least ready for.

Deliverable: A one-page map of the 4 reported rounds, with the weakest marked.

Day 2 — Work System Architecture / Architecture Questions

  • Spend the session on System Architecture / Architecture Questions, which Cleveland Clinic candidates report being tested on.
  • Write one worked example in System Architecture / Architecture Questions and time yourself on it.

Deliverable: One timed worked example in System Architecture / Architecture Questions.

Day 3 — Work MATLAB

  • Spend the session on MATLAB, which Cleveland Clinic candidates report being tested on.
  • Write one worked example in MATLAB and time yourself on it.

Deliverable: One timed worked example in MATLAB.

Day 4 — Work Technical Interview Preparation (Architecture-Centric)

  • Spend the session on Technical Interview Preparation (Architecture-Centric), which Cleveland Clinic candidates report being tested on.
  • Write one worked example in Technical Interview Preparation (Architecture-Centric) and time yourself on it.

Deliverable: One timed worked example in Technical Interview Preparation (Architecture-Centric).

Day 5 — Answer out loud: Technical / Domain Questions

  • Answer aloud, timed: How do you ensure the security of software applications in a healthcare context?
  • Answer aloud, timed: Can you explain the software development lifecycle and your experience with each phase?

Deliverable: Spoken answers to 2 reported Technical / Domain Questions question(s), under time.

Day 6 — Answer out loud: System Design / Architecture

  • Answer aloud, timed: How would you design a scalable application to manage patient records?
  • Answer aloud, timed: What considerations would you take into account when designing a healthcare application for multiple user roles?

Deliverable: Spoken answers to 2 reported System Design / Architecture question(s), under time.

Day 7 — Answer out loud: Behavioral / Leadership

  • Answer aloud, timed: Describe a time when you had to collaborate with team members to achieve a project goal.
  • Answer aloud, timed: How do you handle conflicts within a team?

Deliverable: Spoken answers to 2 reported Behavioral / Leadership question(s), under time.

Behavioural preparation

Behavioural rounds judge the decision you made and what it cost.

Can you explain the software development lifecycle and your experience with each phase?

Medium · Technical / Domain Questions

Approach

  1. Pick a story where you made the decision, not one where you watched it.
  2. State the situation in two sentences and spend the rest on the reasoning.
  3. Give the blast radius: what could have broken, and what you measured.
  4. Name the disagreement and how you resolved it with evidence.

Follow-up

  • What would you do differently if you ran that again?
  • How did you know your change caused the improvement?

Describe a time when you had to collaborate with team members to achieve a project goal.

Medium · Behavioral / Leadership

Approach

  1. Pick a story where you made the decision, not one where you watched it.
  2. State the situation in two sentences and spend the rest on the reasoning.
  3. Give the blast radius: what could have broken, and what you measured.
  4. Name the disagreement and how you resolved it with evidence.

Follow-up

  • What would you do differently if you ran that again?
  • How did you know your change caused the improvement?

How do you handle conflicts within a team?

Medium · Behavioral / Leadership

Approach

  1. Pick a story where you made the decision, not one where you watched it.
  2. State the situation in two sentences and spend the rest on the reasoning.
  3. Give the blast radius: what could have broken, and what you measured.
  4. Name the disagreement and how you resolved it with evidence.

Follow-up

  • What would you do differently if you ran that again?
  • How did you know your change caused the improvement?

What motivates you to work in the healthcare technology space?

Medium · Behavioral / Leadership

Approach

  1. Pick a story where you made the decision, not one where you watched it.
  2. State the situation in two sentences and spend the rest on the reasoning.
  3. Give the blast radius: what could have broken, and what you measured.
  4. Name the disagreement and how you resolved it with evidence.

Follow-up

  • What would you do differently if you ran that again?
  • How did you know your change caused the improvement?

Can you give an example of how you influenced a decision within your team?

Medium · Behavioral / Leadership

Approach

  1. Pick a story where you made the decision, not one where you watched it.
  2. State the situation in two sentences and spend the rest on the reasoning.
  3. Give the blast radius: what could have broken, and what you measured.
  4. Name the disagreement and how you resolved it with evidence.

Follow-up

  • What would you do differently if you ran that again?
  • How did you know your change caused the improvement?