As part of a 245-bed teaching hospital backed by the expertise and resources of Penn Medicine, the Case Management team partners with physicians, nurses, social workers, patients, families, and community agencies to coordinate care, facilitate safe transitions, and address complex medical and psychosocial needs. Coordinate post-discharge services such as home health, rehabilitation, durable medical equipment, skilled nursing facility placement, behavioral health resources, and community support programs to promote continuity of care and reduce avoidable readmissions.