Fraser Health

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Case Manager, Community Mental Health

$29.63 - $36.93
Hope, British Columbia
Early Career


Utilizing the case management model and as part of a multidisciplinary team, the Case Manager, Community Mental Health provides clinical services to clients in Community Residential (CRP) and Adult Community Support Services (ACSS) Programs. The Case Manager works closely with other members of the multi-disciplinary team in assessing clients' mental health status, formulating a plan of care, implementing planned care and evaluating outcomes.

The Case Manager works in partnership with clients, caregivers, facility managers and staff of relevant community and regulatory agencies; participates in planning and developing mental health services and provides community mental health education.


  1. Functions as a primary therapist and case manager, providing diagnostic client assessment and short and long term individual, group, and family therapy, using a variety of interviewing, counselling, and assessment methods, in accordance with professional standards and clinical policies and practices. Manages cases and formulates treatment plans and goals in conjunction with appropriate facility staff, including joint care plans with facility Directors of Care, assigned agency staff, and other services. Uses crisis intervention and outreach as required.
  2. Facilitates clients' utilization of appropriate community services and rehabilitative programs by performing duties such as researching available services, liaising with these agencies, providing related advice and consultation to clients and providing referrals to appropriate community treatment alternatives and services. Utilizes available community resources to develop supportive and rehabilitative programs for adults and their families. Makes arrangements for clients to be admitted to hospital when required, including on an involuntary basis. Makes phone calls to appropriate parties and necessary transportation arrangements.
  3. Provides client care linkages between community mental health services and acute care facilities, including liaising with the Riverview Hospital, acute care hospitals, and the Forensic Psychiatric Hospital to ensure appropriate referrals of clients and to facilitate assessment and care planning for client discharge from hospital. Liaises with Forensic Community Outpatient Clinic. Exchanges relevant client information and receives information about the status and background of clients who will be discharged or referred, in order to make necessary preparations for provision of a smooth continuum of care between acute care and community mental health services.
  4. Assesses clients for placement to and discharge from residential facilities, including specialized residential care licensed facilities, family care homes, congregate care homes and semi-independent living units, by determining eligibility, and type and level of care required. Makes arrangements for client placement and care in residential facilities by liaising with facility operators, placing client names on wait lists, assisting clients to make moving arrangements, and completing necessary referrals and forms. Follows up with clients by visiting them at their accommodation and assessing the appropriateness of the facility and the level of care. Adjusts placements as required.
  5. Provides support and direction to clients requiring enhanced case management by monitoring their mental health status, assessing their social adjustment and ability to perform routine life activities including managing money and taking medication regularly. Provides follow-up care and services as required, including providing referrals to other healthcare professionals such as Recreational Therapists, Occupational Therapists, and Psychiatrists. Updates the Clinical Coordinator on the status of client treatment and progress, as well as significant and unusual issues, developments, and circumstances.
  6. Maintains client records and statistics, prepares reports, and completes forms as required, in accordance with Fraser Health policies and standards, including clinical record standards of Mental Health Services. Obtains consent forms for release of client information.
  7. Advocates on behalf of clients, by performing duties such as providing clients with information about appeal processes, providing information about clients to relevant Ministries, and assisting clients to complete forms. Acts as a resource for clients and their families.
  8. Provides education to clients, their families, and staff of residential facilities and other agencies, regarding community mental health programs and issues.
  9. Participates in quality improvement and risk management activities for assigned area by performing duties such as participating in quality initiatives, providing feedback to the Clinical Coordinator about needs and gaps in programs and services, and suggesting solutions and initiatives to assist in the development and maintenance of a coordinated mental health care system within the community.
  10. Participates as a member of local committees and advisory boards to provide and receive information as a representative of the Community Mental Health team, as assigned.
  11. Participates in clinical research and program evaluation activities relevant to the needs of clients, families, hospitals, and the community, by providing information as requested.
  12. Performs other related duties as assigned.


Bachelor's Degree in Social Work, Clinical Counselling or other relevant health related discipline. Three (3) years' relevant clinical experience in either a hospital or community setting or an equivalent combination of education, training and experience. Valid B.C. driver's license and access to personal vehicle for business related purposes.

Skills and Abilities

  • Demonstrated counselling, client assessment and case management skills.
  • Demonstrated ability to communicate effectively in English, both verbally and in writing, including empathic and respectful communication appropriate to the situation.
  • Demonstrated ability to establish rapport with clients, families, and members of the interdisciplinary team, and including the ability to effectively network with other services and agencies.
  • Demonstrated ability to prioritize and organize work.
  • Demonstrated ability to work independently with minimal supervision.
  • Knowledge of the principles, practices, and theories of Social Work.
  • Knowledge of community resources and methods of accessing them.
  • Comprehensive knowledge of emergency triage procedures, mental health status assessment, and counselling principles and interview techniques.
  • Working knowledge of psychopharmacology, crisis theory, and de-escalation techniques.
  • Working knowledge of DSM IV Multiaxil Diagnosis or International Classification of Diseases 10.
  • Physical ability to carry out the duties of the position.