Case Manager - PATH

Case Manager - PATH

At AllHealth Network, compassion, collaboration, and evidence-based care come together to support individuals and families experiencing homelessness. Our PATH (Projects for Assistance in Transition from Homelessness) outreach team provides intensive, community-based services through street outreach, engagement, and connection to mental health care. The team works collaboratively with community partners to promote access, stability, and long-term recovery. As a Case Manager - PATH, you are essential in delivering direct, community-based services to individuals experiencing homelessness. You will play a key role in outreach, engagement, and care coordination by helping clients access resources, secure housing, and connect to behavioral health services, while supporting recovery-oriented and person-centered care.

Services may include wraparound care navigation to assist individuals with connection to community resources, skills training to help increase independent living, coordination of care with relevant support, individual and family therapy, substance use counseling and psychoeducation. Collaborate with a team-based framework to ensure the effective and efficient delivery of care coordination and case management services, including telephonic and face-to-face contact. Travel as required for hospital visits, provider offices, community-based organizations, and/or home visits; partnering with other ACT team staff. Motivate clients to participate in the program by establishing a therapeutic relationship. Maintain a caseload of clients in accordance with department policy to achieve optimal functioning and sustain improvements in health management. Conduct comprehensive assessments to gather detailed information about a client's unique situation and functioning in order to identify their individual needs. Information gathered should include, but is not limited to, medical, psychosocial, and behavioral health. Develop and implement care plans using a multidisciplinary process that addresses client-identified needs. Assist clients in identifying recovery goals and coordinating services and providers to meet those goals. Utilize professional judgment and critical thinking to support the client in overcoming barriers to goal achievement. Modify care plans as necessary. Act as a client advocate and liaison between internal and external providers, community resources, and criminal justice partners to seamlessly integrate and coordinate services. Provide clinical and coaching services consistent with the client's readiness to change and engagement. Interventions may include, but are not limited to, motivational interviewing to facilitate health behavior change, cognitive behavioral strategies, skills-based training, and self-management support. Make referrals to community-based organizations and resources that align with the identified needs in the plan of care or by the client. Positively contribute to the financial health of the organization by ensuring the delivery of billable services and utilizing, monitoring, and collecting data for decision-making and program improvements. Maintain a positive, ethical, and professional working relationship with community, government agencies, and other professionals. Participate and contribute to departmental meetings, team huddles, rounds, supervision, and other meetings as needed to ensure cohesive department operations. Enhance professional growth and development through participation in specialized training. Perform case management services consistent with ethical and professional standards established by CMSA and disciplines pertinent to the employee.

Bachelor's degree in a relevant clinical field such as Social Work, Clinical Psychology, or Counseling. Minimum of two (2) years of related clinical experience serving diverse populations in behavioral health, physical health, or criminal justice settings. Demonstrated experience in case management, care coordination, and community-based services. Strong assessment, care planning, and clinical documentation skills. Working knowledge of community resources, treatment options, funding sources, and support programs. Proficiency with PC-based software systems, including Word, Excel, PowerPoint, and electronic systems. Excellent written and verbal communication, time management, problem-solving, and decision-making skills. Ability to work independently while contributing effectively within a multidisciplinary team environment. Must possess reliable transportation, a valid driver's license, a good driving record, and proof of insurance