Multiple condition formula

I hope the title is appropriate though It doesn't fully express what I need. I need a formula that is basically an IF OR UNLESS statement. When you type that into Google it has nothing to do with Excel.

The formula below says is that if G40 = any of the following then the cell should fill with "Not Changed" but if P40 is less than Q1 which is a Gross profit percentage then subtract S40 from E40 and populate the cell with the answer. E40 = a billing rate and S40 is that billing rate times Q1. The formula is either calculating a new pay rate for me or not changing the old rate and placing "Not Changed" in the field. The problem now is that I also need the formula to take into consideration another job title (Column G) + a company name (Column M) and instead of using the percentage used in Q1 use a percentage in R1.

Is this even possible. Please let me know if this is not understood.

=IF(OR(G40="Behavioral Specialist Consult",G40="Mobile Therapist",G40="Lead Clinician",G40="Licensed Clinician/New Jersey",G40="Psychologist / Psychiatrist",G40="Non Licensed Clinician",G40="Counselor"),"Not Changed",IF(P40<$Q$1,E40-S40,"Not Changed"))

THANK YOU TO ALL OF YOU WHO ARE TEACHING ME!