Sal, your experience at bed side sounds impressive, but you are correct to pause and assess what the correct decision is for your new case management career. On one hand, familiarity with one hospital culture is an advantage, knowing your floor, MD colleagues etc. On other hand, a good orientation to take you to that next level is really important. Large institutions might pay for hospital criteria Milliman training. In addition to join a reputed institution would increase your marketability as an RN CM even further, plus if it's a tertiary institution like mine trauma, cancer center, peds, med school. I am only 3 years at my place, everyone seems to have gotten comfortable w/ me, me with them MDs, floor RNs, cafeteria staff you name it LOL. Of course, my institution does have a culture of kindness program, so you should assess offer no. 2. As you can guess from my userid, vibe is important.