Systemic consultation is a form of tertiary case supervision derived from the principles of systemic family therapy. The present study defines the process and outcomes of systemic consultation through the experiences of case managers (CMs) working with people who have an intellectual disability. CMs were invited to present and discuss one of their complex cases with a team of consultants and attend a follow up session 4 to 6 weeks later. Measures of levels of stress, perception of workplace functioning, and workflow information were completed pre and post-intervention and compared to measures completed by a second group of CMs receiving regular supervision only. After participation in systemic consultation, the networks of people CMs consulted about the case were significantly smaller and they scored significantly higher on a network measure of efficiency of information flow. The CMs experienced lower levels of stress and higher perception of workplace functioning, these differences approached significance. After attending the consultation outcome, themes included a reduced sense of being stuck and stressed, becoming an agent of change and taking perspective. The approach allows CMs space for reflection on practice and new perspectives to be heard. Case management has been under-represented in documented research and evidence-based training and supervision models, and is an area in which professional theory appears to be lacking.