Case Manager, ACT

Position Summary

Assertive Community Treatment (ACT) is an evidence-based practice that improves outcomes for adults with severe and persistent mental illness (SPMI) who are most at-risk of psychiatric crisis, hospitalization, and involvement with the criminal justice system. The Community & Mental Health Worker provides community-based support with a focus on promoting recovery, improving access to services, and addressing social determinants of health. This individual works closely with other ACT team members to ensure comprehensive, person-centered care that supports clients’ recovery and well‑being.

• Provide direct support to clients in the community, addressing daily living needs, such as housing, employment, and transportation.
• Provide on‑call support and intervention on a rotating schedule, including evening, weekend, and holiday hours as scheduled.
• Transport clients to medical appointments or community resources as needed.
• Advocate for clients within healthcare and social service systems to ensure access to needed resources and support.
• Assist clients in developing and implementing individualized recovery plans.
• Support clients in managing their mental health conditions through education, encouragement, and skill-building.
• Facilitate connections to other health services and community resources like food banks, housing assistance, etc.
• Provide crisis intervention and de‑escalation as needed, in collaboration with the ACT team.
• Educate clients on managing physical and mental health conditions, including wellness strategies and preventive care.
• Guide clients in navigating healthcare systems and accessing medical care.
• Work collaboratively with ACT team members, including nurses, therapists, and peer specialists, to ensure holistic care.
• Participate in regular team meetings to discuss client progress and coordinate care.
• Share insights and observations from the field to inform treatment plans and interventions.
• Promote recovery‑oriented, trauma‑informed care that fosters independence and wellness.
• Complete all required documentation in a timely and accurate manner, including but not limited to treatment plans, progress notes, and discharge summaries.
• Participate in quality improvement initiatives and ensure fidelity to ACT model standards.
• Perform other job‑related duties as needed.

• Strong interpersonal and communication skills with the ability to engage and build rapport with diverse populations.
• Knowledge of behavioral health principles, social determinants of health, and trauma‑informed care.
• Ability to work independently and collaboratively in a dynamic, team‑oriented environment.
• Strong organizational and problem‑solving skills to manage multiple priorities effectively.
• Proficiency in Microsoft Office Suite and electronic health record systems.
• Awareness and sensitivity of our constituents and the populations served by employees.
• Regular and predictable attendance, and promptness for work.
• Commitment to uphold the mission, vision, and values of Lutheran Family Services.
• Support Lutheran Family Services in the organization’s objective to be a diverse, equitable, inclusive, and accessible workplace.

• Helping
• Advocacy
• Communication Skills
• Organization
• Empathy

• Bachelor’s degree in social work, psychology, public health, or a related field required.
• At least 1 year of experience in community health, mental health, or related field.
• Familiarity with the ACT model and community‑based care strongly preferred.
• Demonstrated understanding of and ability to work with people of diverse backgrounds.
• Bilingual in English and another language preferred (desired languages align with languages spoken by our client populations, including but not limited to Spanish, Arabic, etc.).

• Prolonged periods of standing, walking, driving, and sitting at a desk and using a computer.
• In‑office work and field environment with travel to other worksites and/or community sites.
• Company‑issued laptop and cell phone.
• Provide on‑call support and intervention as needed, including evening, weekend, and holiday hours.
• Valid driver’s license, proof of liability auto insurance, and ability to drive a personal vehicle on a daily basis to transport clients safely within the community.

Lutheran Family Services is an equal opportunity employer. We do not discriminate against any employee or applicant for employment on the basis of age, race, religion, color, ethnicity, disability, gender, sexual orientation, gender identity, or national origin.