Quality Assurance Specialist TTECQuality Assurance SpecialistCharlotte, NCReview and evaluate operational procedures, including Customer Service interactions from all communication channels, service requests, refund processing, Transponder fulfillment, outgoing correspondence, and future quality review implementations. Assists the Quality/Training Manager and Assistant Manager in auditing Key Performance Indicators (KPIs) for TTEC Operations, like outgoing correspondence and external survey results.
NewProduction Control Specialist Accentuate StaffingProduction Control SpecialistYoungsville, NC$25–$28 / hourFull timeThis position requires excellent organizational skills, attention to detail, and the ability to analyze production data while collaborating with production, warehouse, and planning teams. The successful candidate will help ensure inventory accuracy, maintain production records, generate key performance metrics, and support overall operational efficiency.
NewSenior Operations Specialist JobotSenior Operations SpecialistCharlotte, NC$80,000–$120,000 / yearInformation collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Growing and dynamic organization that is involved in the design, development, and manufacturing of electrical products for the North American market, drawing on extensive industry experience and established technologies to deliver high-quality solutions.
NewPayroll Specialist JobotPayroll SpecialistRaleigh, NC$70,000–$90,000 / yearInformation collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Our client was recognized by Fortune as one of the 100 Best Companies to Work For, is seeking a Payroll Specialist to join its corporate team in Raleigh, NC.
NewClinical Nurse Specialist (CNS Certified) - Cardiac Stepdown Duke HealthClinical Nurse Specialist (CNS Certified) - Cardiac StepdownDurham, NCIf you are looking for an opportunity to influence cardiovascular care at scale, mentor the next generation of nurses, lead meaningful quality and safety improvements, and practice within one of the nation's most established CNS programs, we invite you to explore a career with Duke Health. As a member of Duke Health's robust Clinical Nurse Specialist practice, you will join a collaborative community of more than 35 CNSs across multiple specialties while working alongside a dedicated Cardiovascular Critical Care CNS to support seamless care across the Heart Center.
NewPatient Access Specialist CornerStone StaffingPatient Access SpecialistCary, NCAs a Health Services Specialist, you will serve as a key liaison between patients, providers, payers, and internal teams to ensure accurate documentation, efficient case management, and a positive patient experience while maintaining compliance with healthcare regulations. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from CornerStone and its affiliates, and contracted partners.
Claims Legal Specialist - Conditional Demands Sentry InsuranceClaims Legal Specialist - Conditional DemandsGoldsboro, NC$31.25–$37.50Experience in handling conditional demands, preferably including bodily injury claims, on behalf of an insurer as an attorney, technical specialist, claims manager or similar role sufficient in one more of the following states to develop a high degree of technical expertise: CA, FL, TX, GA, or SC. Act as a subject matter expert, provide technical advice, direction, and guidance to other claims associates as need arises including instruction and authority on all complex conditional settlement demands received by enterprise.
NewTalent Acquisition Specialist II # 26-17882 US Tech Solutions, Inc.Talent Acquisition Specialist II # 26-17882Durham, NCYou will partner with HR Directors/Business Partners, hiring managers (including senior leaders and Vice Presidents), external outsourcing partners and agencies to develop TA strategies aligned with position, skill, and long-term requirements of the business, resulting in the achievement of key objectives (e.g. Additional job duties include pre-screening candidates, partnering with team members to develop sourcing strategies and providing talent for open positions.
Communication Specialist III - # 26-17060 US Tech Solutions, Inc.Communication Specialist III - # 26-17060Charlotte, NCWorking closely with the Lead Communications Manager, this role helps ensure leaders are prepared, large-scale events are executed flawlessly and enterprise strategy and key messages are consistently delivered. Job Description: The role supports leadership engagement planning, communications development and operational execution for Client’s senior leadership meetings and enterprise-wide events.
Porsche Brand Ambassador/Client Specialist Hendrick Automotive Group CorporatePorsche Brand Ambassador/Client SpecialistCharlotte, North CarolinaFull timeWork includes frequent movement around the company facilities and the outdoor car lot to interact with customers and other departments. Completes paperwork accompanying vehicle sales, including but not limited to, preparing sales slip or sales contract.
Audi Brand Specialist Hendrick Automotive Group CorporateAudi Brand SpecialistCharlotte, North CarolinaFull timeWork includes frequent movement around the company facilities and the outdoor car lot to interact with customers and other departments. Completes paperwork accompanying vehicle sales, including but not limited to, preparing sales slip or sales contract.
Registered Nurse Post Acute Transition Specialist CarePartnersRegistered Nurse Post Acute Transition SpecialistMorganton, NCThe Post-Acute Transitions Specialist will ensure appropriate patient placement through screenings and assessments in collaboration with SNF Discharge Planners & Inter- Disciplinary Teams, Ambulatory Care Managers, MHP Care Managers, BPCI Transitions Care Coordinator, practice referral coordinators, physicians, and CarePartners Post-Acute service line team members. They will maximize positive financial outcomes for designated patient populations, intervening at key points in the disease process by facilitating appropriate Post-Acute placement, participating in Goals of Care/Advanced Care Planning dialogue and effective transitions to prevent readmissions, and lower total cost of care thru the appropriate utilization of Post-Acute services.
NewSpecialist - Software Development & Engineering Charles SchwabSpecialist - Software Development & EngineeringRaleigh, NCWealth and Asset Management (WAM) engineering is an organization within Schwab Technology Services aligned to support the technology needs of Schwab Asset Management (SAM), Wealth & Advice Solutions (WAS), the Schwab Center for Financial Research (SCFR), and Third-Party Platform teams. • 1-2 years of experience managing the software development lifecycle with capabilities including C#, HTML5, Angular/Backbone, JavaScript, JQuery, JSON, XML, REST, SOAP, responsive web design, & design patterns.
Cardiovascular Specialist - Rex Invasive Heart & Vascular UNC HealthCardiovascular Specialist - Rex Invasive Heart & VascularRaleigh, NC$33.04–$47.50 / hourIf you're passionate about cardiovascular nursing, enjoy working in a high-performing procedural environment, and want to make a difference when every second counts, we'd love to meet you. Our Cardiac Catheterization Laboratory is a high-energy, fast-paced environment where skilled professionals work together to deliver life-saving care when patients need it most.
M&A Tax Specialist Diedre Moire Corp.M&A Tax SpecialistCharlotte, NC$300,000–$400,000 / yearFull timeCONSIDERED EXPERIENCE INCLUDES: Tax Accountant Attorney Mergers Acquisitions Divestitures Equity Funds Tax JD CPA MBA Representations Warranties Insurance RWI Transactional Risk Insurance #DiedreMoire #JobSearch #JobHunt #JobOpening #Hiring #Job #Jobs #Careers #Employment #jobposting #InsuranceJobs. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers.
NewAdministrative Specialist - Children's Operating Room UNC HealthAdministrative Specialist - Children's Operating RoomChapel Hill, NC$19.12–$27.17 / hourDemonstrates the ability to learn and master the scheduling system as appropriate Coachability: Receptive to feedback, willing to learn and embraces continuous improvement Accountability: Manages performance to meet expected results. Our Children's OR staff are able to work in multiple service areas, including Neurosurgery, Orthopedics, ENT, Oral Maxillofacial, Burns, Ophthalmology, General Surgery, Plastics, Urology, and Dental Surgery.
NewBehavioral Health Specialist Only LCSWs Oak Street HealthBehavioral Health Specialist Only LCSWsHigh Point, NC$54,095–$129,615The Behavioral Health Specialist will assess the needs of patients, make referrals to appropriate behavioral health resources and specialists, and provide short-term counseling and evidence-based treatments as indicated. The purpose of a Behavioral Health Specialist at Oak Street Health is to provide care management services and to provide evidence-based short-term psychotherapy to our patients with behavioral health needs.
NewClinical Dietitian - Disease Management Duke HealthClinical Dietitian - Disease ManagementRaleigh, NCThese areas include: Student Advisor, Malnutrition Specialist, Adult Nutrition Support Specialist, Pediatric Nutrition Support Specialist, Program Coordinator, Clinical and Quality Specialist, IT Specialist, Outpatient Clinical Coordinator, Lead, Subject Matter Expert. Coordinate all phases of nutrition care including nutrition assessment, care planning, monitoring, education and counseling of hospitalized patients and outpatients in a variety of settings.
Sr QA Specialist - Quality Risk Management Thermo Fisher Scientific IncSr QA Specialist - Quality Risk ManagementGreenville, NCYou will partner cross functionally to drive quality excellence, ensure compliance with global regulatory requirements, and strengthen quality systems that support safe and effective products. Discover Impactful Work: As a Senior Quality Specialist, you will provide technical leadership and oversight within GMP manufacturing environments.
NewQuality Engineer / Quality Systems Specialist Stark Pharma SolutionsQuality Engineer / Quality Systems SpecialistDurham, NCContract Quality Engineer / Quality Systems SpecialistLocation: Durham, NCDuration: Long TermWe are seeking an experienced Quality Engineer / Quality Systems Specialist to support a fast‑paced FDA‑regulated medical device manufacturing environment. This role will focus on driving CAPAs, Non‑Conformances, investigations, and Quality System improvements while helping reduce quality backlog and ensuring compliance with regulatory requirements.
Quality Specialist Junior Quality Engineer Hitachi LtdQuality Specialist Junior Quality EngineerMorganton, NCIf you are passionate about continuous improvement, thrive in a detail-focused environment, and enjoy working in a collaborative, team-oriented setting, this is an opportunity to make a meaningful impact while growing your expertise in quality and manufacturing. You'll be empowered to use data-driven insights, problem-solving skills, and quality tools to identify opportunities, reduce defects, and elevate performance across the production lifecycle.
QA Specialist II, Quality Operations (Combination Products) United TherapeuticsQA Specialist II, Quality Operations (Combination Products)Research Triangle Park, NCMinimum Requirements + Bachelor’s Degree in a scientific or related technical discipline + 2+ years of relevant pharmaceutical industry experience in a cGMP regulated environment + Ability to work independently and as part of a multi-functional team, being able to manage and prioritize workloads, stressful situations, and deadlines and work extended hours to support business needs + Able to work extended hours to support business needs, as applicable + Ability to effectively communicate with internal customers at various levels in the organization; written and oral + Ability to handle confidential company data, projects, information, etc. + Ability to interpret data in relation to a vast number of company procedures as well as current GMP requirements + Experience in review of batch records, production records, process control records + Proficient in Microsoft Excel, Word, and Adobe Acrobat Preferred Requirements + 2+ years of experience in combination products + Knowledge of Enterprise Resource Planning System (ERP), TrackWise Digital, Systems Application and Products (SAP S4HANA), and MasterControl Job Location United Therapeutics requires this candidate to be on-site at our RTP, North Carolina location 100% of the time.
Senior QA Specialist, Quality Operations (Combination Products) United TherapeuticsSenior QA Specialist, Quality Operations (Combination Products)Research Triangle Park, NCEscalate unresolved issues or concerns to Quality Management and affected area management + Participate in client meetings and projects as it relates to manufacturing, product scheduling, batch records, supply chain, etc. to support product pipelines + Support regulatory authority (FDA, MHRA, EMA, QP, etc.) inspections and internal audits, including documentation audit team, pre-audit facility inspections, etc Minimum Requirements + Bachelor’s Degree in a scientific or related technical discipline + 5+ years of relevant pharmaceutical industry experience in a cGMP regulated environment + Ability to work independently and part of a multi-functional team, being able to manage and prioritize workloads, stressful situations, and deadlines and work extended hours to support business needs + Able to work extended hours to support business needs, as applicable + Experience in review of batch records, production records, process control records + Ability to interpret data in relation to a vast number of company procedures as well as current GMP requirements + Ability to effectively communicate (written and oral) with internal and external customers at various levels in the organization + Ability to handle confidential company data, projects, information, etc. + Review GMP documentation, including logbooks, pest control, waterlogs, calibration and maintenance reports, temperature monitoring, batch records, protocols, etc., as it relates to Combination products for accuracy, completeness, and compliance with UT policies and procedures + Perform quality assurance functions, including inspection of production equipment for cleanliness, gowning, area line clearances, in-process packaging checks, AQL inspections and floor audits, in support of manufacturing and packaging operations + Review and disposition manufacturing, packaging and Combination Products batch records and raw materials and components for clinical and commercial processes + Review of quality control final product and stability data + Process rejected lots of raw materials, components and Combination products identified for destruction.
QA Specialist – Medical Device Manufacturing | 2nd Shift | $27+/hr | Manpower EngineeringQA Specialist – Medical Device Manufacturing | 2nd Shift | $27+/hr |Mebane, NC$27.10–$27.50 / hourTemporaryp> ManpowerGroup® (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2022 ManpowerGroup was named one of the World's Most Ethical Companies for the 13th year - all confirming our position as the brand of choice for in-demand talent.
KBI: US - Principal QA Specialist KBI Biopharma IncKBI: US - Principal QA SpecialistDurham, NC$113,000–$156,000 / yearProvides QA oversight of analytical and microbial laboratory activities including but not limited to method qualification, method transfers, method validations, creation and revision of test methods, specifications, stability studies, laboratory investigations and laboratory deviations. The Principal QA Specialist provides exemplary service to both internal and external customers by ensuring patient safety and regulatory compliance while supporting product lifecycle activities for timely delivery of products to clients for patients.
NewSr. Quality Specialist Grifols SASr. Quality SpecialistNCManage the qualification and requalification of distributors, 3PLs, product and service providers, and transportation partners in accordance with regulatory requirements and Global Marketing decisions; ensure all (re)qualification records are maintained and archived per established procedures. The role manages key quality activities including audits, supplier and distributor qualification, change controls, risk assessments, KPIs, and quality system documentation to ensure ongoing regulatory compliance.
KBI: US - Principal QA Specialist KBI BiopharmaKBI: US - Principal QA SpecialistDurham, North CarolinaProvides QA oversight of analytical and microbial laboratory activities including but not limited to method qualification, method transfers, method validations, creation and revision of test methods, specifications, stability studies, laboratory investigations and laboratory deviations. The Principal QA Specialist provides exemplary service to both internal and external customers by ensuring patient safety and regulatory compliance while supporting product lifecycle activities for timely delivery of products to clients for patients.
Quality Specialist / Junior Quality Engineer HitachiQuality Specialist / Junior Quality EngineerMorganton, VirginiaIf you are passionate about continuous improvement, thrive in a detail-focused environment, and enjoy working in a collaborative, team-oriented setting, this is an opportunity to make a meaningful impact while growing your expertise in quality and manufacturing. You’ll be empowered to use data-driven insights, problem-solving skills, and quality tools to identify opportunities, reduce defects, and elevate performance across the production lifecycle.
NewSr. Quality Specialist Integrated Resources, IncSr. Quality SpecialistRocky Mount, North CarolinaFull timePlease include actual tasks and/or essential responsibilities that highlight accountability and level of judgment required.2-5 years' experience in pharmaceutical quality environment requiredExperience in sterile manufacturing and an understanding of the sterilization process and its impact to products. Prior investigation writing experience (with determination of product impact).Strong oral and written communication presentation, interpersonal skills and adept at communication with employees at all levels within the organization.
NewQuality Specialist - 1st Shift - RPO Eaton Corporation PlcQuality Specialist - 1st Shift - RPORaleigh, NCAfter making a conditional offer and running a background check, if Eaton is concerned about conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. In this function you will: Assist in quality audits, workmanship defect reduction efforts, corrective and preventive action identification, analysis and reporting, inspection of returned units, special inspections.
Quality Specialist, Staff Curtiss-Wright CorporationQuality Specialist, StaffShelby, NC$21.01–$30.33 / hourCurtiss-Wright Actuation Division designs, manufactures, and supports electro-mechanical actuation products and systems for use in demanding applications in Aerospace, Defense and Industrial Automation markets. Our market leading solutions help improve the reliability, efficiency and performance of our customers' operations and platforms, as well as reducing their environmental impact with energy efficient electro-mechanical designs and technology.
Advanced Practice Provider (NP/PA) - Clinical Quality Specialist I - EPIC Certified Avance CareAdvanced Practice Provider (NP/PA) - Clinical Quality Specialist I - EPIC CertifiedDurham, North CarolinaFull timeAvance Care is seeking an experienced Advanced Practice Provider (Nurse Practitioner or Physician Assistant) for an exciting opportunity to grow your career in a role that offers both meaningful patient connection and broader organizational impact. If you’re looking for a role where you can care for patients, influence meaningful change, and grow as a clinical leader, we invite you to join Avance Care and be part of the future of high-quality, data-driven healthcare.
QA Specialist I Utility Construction Projects # 25 -15862 US Tech Solutions, Inc.QA Specialist I Utility Construction Projects # 25 -15862Charlotte, NC$30–$40 / hourThis includes tracking project status, monitoring document inventories, supporting final quality control (QC) processes, and ensuring project documentation is complete, accurate, and aligned with PIM program requirements. This position interfaces with project teams, contractors, vendors, and internal stakeholders to track deliverables, identify gaps, and communicate project status, risks, and dependencies related to document control, turnover, and closeout activities.
QA Specialist (GMP) – 3rd Shift | $27.50/hr | 3 Month Contract | Onsite Manpower EngineeringQA Specialist (GMP) – 3rd Shift | $27.50/hr | 3 Month Contract | OnsiteMebane, NC$27.10–$27.50 / hourTemporaryp> ManpowerGroup® (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2022 ManpowerGroup was named one of the World's Most Ethical Companies for the 13th year - all confirming our position as the brand of choice for in-demand talent.
NewSupplier Quality Specialist - Audits & Compliance Masis Professional GroupSupplier Quality Specialist - Audits & ComplianceCharlotte, NCPreferredSAP and Quality Management System experienceBenefits45 Days of Fully Furnished Temporary Housing$5,000 Relocation StipendPaid Area Exploration VisitsWeekly PayChristmas Eve–New Year's ShutdownUp to $5,000 Annual Tuition ReimbursementGym/Fitness ReimbursementCompany-Paid Life InsuranceCompany-Paid Short-Term DisabilityEmployee Assistance Program (EAP)Annual HSA Contribution#J-18808-Ljbffr. Supplier Quality Specialist – Audits & Compliance30-45 minutes of Charlotte, NC$85k-$100k + discretionary bonus potential up to 12% of YTD earningsUS Citizens or Green Card Holders only | No C2CThe Supplier Quality Specialist – Audits & Compliance reports to the Supplier Quality and Compliance Manager.
Quality Systems Specialist The Cheesecake Factory IncQuality Systems SpecialistNC$65,000–$75,000 / yearAbout the Company: Our state-of-the-art The Cheesecake Factory Bakery creates over 35,000 delicious cheesecakes per day across our two facilities in Calabasas, CA and Rocky Mountain, NC plus other baked products for our restaurants, international licensees, and third-party bakery customers. Working collaboratively with Quality Assurance, Operations, Sanitation, Maintenance, and Regulatory teams, this role ensures that written programs accurately reflect plant practices and are consistently audit ready.
Quality Specialist Becton Dickinson and CoQuality SpecialistNC$95,900–$153,400 / yearBuild and maintain strong cross-functional relationships, enabling collaboration across all levels while leading or supporting end-to-end QMS activities and initiatives. For most roles, we require a minimum of 4 days of in-office presence per week to maintain our culture of excellence and ensure smooth operations, while also recognizing the importance of flexibility and work-life balance.
Quality Specialist- Performance Improvement Vidant Medical CenterQuality Specialist- Performance ImprovementGreenville, NCECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
Sr. Quality Specialist - cGMP Manufacturing - 12-Hr Night Shift 2-2-3 Alcami CorporationSr. Quality Specialist - cGMP Manufacturing - 12-Hr Night Shift 2-2-3Morrisville, North CarolinaFull timeAt Alcami, we deliver reliable solutions that unlock the potential of transformative medicines from discovery to commercialization, through trusted partnership with our clients, recognized industry expertise and proven regulatory track record. Job Summary: The Senior Quality Assurance Specialist is accountable for driving results in a fast-paced environment by effectively performing activities as directed to ensure quality and compliance with applicable regulatory requirements and internal procedures.
Quality Specialist III Precision BiosciencesQuality Specialist IIIDurham, NCRequired: Bachelor’s degree in Biology, Biochemistry, Chemistry, Microbiology, or a related life sciences discipline and 5+ years of relevant experience in a GMP-regulated environment, including background in quality assurance, research, or biopharmaceutical/gene therapy manufacturing, or equivalent combination of education and experience. The Quality Specialist III is responsible for providing dedicated quality assurance support for Chemistry, Manufacturing, and Controls (CMC) operations at Precision BioSciences, including batch release review, deviation assessment, and CDMO oversight.
Quality Specialist III Precision Biosciences IncQuality Specialist IIIDurham, NCRequired: Bachelors degree in Biology, Biochemistry, Chemistry, Microbiology, or a related life sciences discipline and 5+ years of relevant experience in a GMP-regulated environment, including background in quality assurance, research, or biopharmaceutical/gene therapy manufacturing, or equivalent combination of education and experience. The Quality Specialist III is responsible for providing dedicated quality assurance support for Chemistry, Manufacturing, and Controls (CMC) operations at Precision BioSciences, including batch release review, deviation assessment, and CDMO oversight.
Supplier Quality Specialist Guerbet SASupplier Quality SpecialistRaleigh, NCWhen you join Guerbet, you: Are choosing a global leader with recognized expertise in diagnostic and interventional imaging, Are joining our 2820 collaborators who are committed every day to offering innovative solutions to improve quality of patient's life all over the world, Are joining a company where we value diversity of talents coming from various horizon. Provide ongoing quality oversight of suppliers supporting GMP manufacturing, including raw materials, consumables, external laboratories, and transportation providers.
Quality Assurance Area Specialist III (QA for Utilities) Novo Nordisk ASQuality Assurance Area Specialist III (QA for Utilities)Clayton, NCDemonstrated expertise in Regulations & quality systems in one or more of the following: product disposition, DV/CAPA, Change Control, Audits, Supplier Management, Project Management, Validation, laboratory method and equipment validation, warehouse/logistics, and IT preferred. Our Product Supply Aseptic Manufacturing (PS AM) facility in Clayton, NC is a 457,000 square foot aseptic "fill and finish" site that is responsible for producing innovative, injectable diabetes and obesity treatments.
Quality Systems Improvement Specialist Guerbet SAQuality Systems Improvement SpecialistRaleigh, NCWhen you join Guerbet, you: Are choosing a global leader with recognized expertise in diagnostic and interventional imaging, Are joining our 2820 collaborators who are committed every day to offering innovative solutions to improve quality of patient's life all over the world, Are joining a company where we value diversity of talents coming from various horizon. Working cross-functionally with Quality, Operations, and other stakeholders, the Specialist ensures quality systems are robust, compliant, and effectively embedded across the organization.
Senior QA Specialist Deviations and CAPAs KBI Biopharma IncSenior QA Specialist Deviations and CAPAsDurham, NCJob Responsibilities: Works directly with Manufacturing, QA and other departments responsible for GMP activities to resolve production related deviations and other compliance issues in a timely manner. Minimum Requirements: Minimum BS in scientific field with 14+ years' experience or MS and 11+ years' experience in a QA cGMP regulated environment within Biopharmaceuticals or equivalent.