The psychological needs of college students lead to overwhelming demand on college counseling centers' resources. In this article, we review models of case management in Higher Education including the administrative, behavioral intervention, and counseling center models. We also present a case study of the 3-year development of a counseling center case management service. Initial data suggest that expanding the role of a counseling center case manager to allow for frequent appointments/follow-up and standardizing counseling center case management procedures led to improved appointment attendance and increased communication with students following referral. A vignette and suggestions for other centers are also presented.