Hospital to Housing Case Manager

St. Louis , MO 63101

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Position Description

The Hospital to Housing (H2H) Case Manager is part of the Assertive Community Treatment (ACT) multidisciplinary team. The H2H Case Manager will provide treatment, rehabilitation, advocacy and case management services to clients within the program with serious and persistent mental illnesses and co-occurring substance use disorders.

• Work directly with BJC Hospital social worker to engage, accept and process referrals into the H2H program
• Conduct comprehensive ongoing assessments of mental illness, physical health, housing status and other relevant needs of each H2H client
• Facilitate move-in process: housing application, rent payment, move-in kits and physical move-in within 30 days of referral
• Manage primary case load by completing treatment plans, DLA-20s and coordinating care through monthly client schedules
• Provide person centered direct clinical services to clients on an individual and group basis in office and community settings and make appropriate changes in client treatment plans to ensure ability to cope with internal and external stressors
• Facilitate treatment planning with emphasis on fostering personal growth and development towards recovery and wellness of each client
• Refer and assist clients to appropriate community agencies when needed
• Assist clients in recovery process by making and keeping appointments and as well as other tasks
• Act as advocate and liaison, consulting with community agencies and program clients to maintain coordination in treatment process
• Collaborate with other members of the ACT team during daily and weekly staff meetings
• Facilitate stage-wise substance abuse treatment interventions with emphasis on personal growth and development towards recovery and wellness
• Coordinate with outside inpatient services to provide needed services and establish links with treatment groups and support networks for each client
• Coordinate application process for entitlement benefits (Social Security, Medicaid, food stamps, etc.)
• Provide on-call crisis intervention in coordination with ACT team members, covering nighttime hours, holidays and weekends
• Maintain St. Patrick Center client tracking system and client files including treatment plans, document client progress by maintaining permanent record of activity within 24 hour time frame required by DMH and BJC/administrative agent
• Be responsible for agency policy regarding work hours, building security and all written personnel standards
• Ensure the care model when interacting with all other St. Patrick Center programs


• BA, BSW preferred with minimum 2 years of experience from an accredited university
• Must be a Qualified Mental Health Professional
• Understanding of mental illness and substance use
• Experience in counseling and case management/wrap-around services
• Experience in conducting home visits
• Knowledge and understanding of community agencies
• Knowledge of federal, state and agency HIPAA policies
• Must possess current Class E Driver’s license (MO residents only)

• Excellent verbal and written communication skills
• Counseling and crisis intervention expertise
• Self-motivation due to the autonomous nature of the position
• Respect for clients and staff
• Sensitivity to cultural diversity
• Ability to work in a team atmosphere
• Moderate computer skills

• Report to and work with ACT Assistant Team Lead
• Attend and participate in all appropriate St. Patrick Center meetings

• Mileage reimbursement
• Off site trainings
• Partner agencies (networking opportunities)

Type: Full-time