Roles and Job Descriptions

A Home and Community-Based Services-Adult Mental Health (HCBS-AMH) Peer Support Specialist is a professional with personal, lived experience in behavioral health recovery who guides program participants transitioning out of institutional settings or managing serious mental illness (SMI) back into community-based life. 

 

Job Description & Core Responsibilities

An HCBS-AMH Peer Support Specialist works within an interdisciplinary team to foster independence, long-term recovery, and community integration. Key duties typically include: 

• Individual Recovery Coaching: Actively utilizing shared lived experience to instill hope, model coping techniques, and build collaborative recovery strategies with program participants. 

• Group Facilitation: Starting and sustaining mutual support, symptom-management, and educational groups tailored to the needs of the participants. 

• Community Integration & Advocacy: Assisting individuals in cultivating social skills, navigating local healthcare and social service systems, and locating stable community resources. 

• Interdisciplinary Collaboration: Participating in team meetings with provider agencies, nurses, and recovery managers to build out individual recovery plans (IRPs). 

• Documentation: Entering clinical notes, tracking milestones, and maintaining precise documentation of peer support services rendered in alignment with Texas Medicaid billing standards. 

 

Mandatory Job Requirements & Qualifications

To work as a Medicaid-billing HCBS-AMH Peer Support Specialist in Texas, candidates must satisfy strict state and administrative criteria: 

• Age: Must be at least 18 years of age. 

• Education: High school diploma or General Equivalency Diploma (GED) is strictly required. 

• Lived Experience: Credible, personal lived experience with a mental health condition, substance use issue, or co-occurring disorders, along with a demonstrated commitment to long-term wellness. 

• Texas Peer Certification: Must hold a current certification approved by the Texas Health and Human Services Commission (HHSC). Common credentials accepted by provider agencies include:

  • Mental Health Peer Specialist (MHPS)

  • Recovery Support Peer Specialist (RSPS)

  • Re-Entry Peer Specialist (JI-RPS) for individuals with justice-system involvement 

• Core Legal/Ethical Competencies: Deep knowledge of the Texas Peer Specialist Code of Ethics, trauma-informed care models, and harm-reduction practices.

• Mobility & Transit: A valid Texas Driver's License and active auto insurance are generally required, as this position involves driving to meet participants directly in their homes or communities. 

A HCBS-AMH Psychosocial Rehabilitation Specialist focuses on clinical skill-building, behavioral intervention, and functional restoration. While a Peer Support Specialist uses shared personal lived experience, the Psychosocial Specialist provides evidence-based, structured cognitive and social interventions to help participants achieve maximum independence. 

 

Job Description & Core Responsibilities

A Psychosocial Rehabilitation Specialist works directly in individuals' homes or community settings to deliver goal-oriented rehabilitation. Key duties include: 

• Psychosocial Skills Training: Teaching and restoring critical independent living skills, including budgeting, symptom management, emotional regulation, and navigating public transportation. 

• Behavioral Interventions: Developing and implementing individualized behavioral and cognitive strategies to address complex barriers to recovery, such as self-harm, aggression, or trauma triggers. 

• Employment Support Integration: Helping participants develop the foundational social, communication, and task-oriented behaviors necessary to prepare for or maintain employment. 

• Recovery Team Contribution: Actively participating in multidisciplinary recovery team meetings to translate an individual's goals into measurable objectives within the Individual Recovery Plan (IRP). 

• Crisis Prevention: Evaluating mental health stability, recognizing early decompensation cues, and implementing trauma-informed crisis avoidance techniques. 

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Mandatory Job Requirements & Qualifications

Unlike Peer Support roles, Texas Medicaid billing regulations require a Psychosocial Specialist to have a formal academic background in behavioral health:

• Education: Minimum of a Bachelor's degree from an accredited college or university with a major in psychology, social work, counseling, sociology, rehabilitation, or a closely related human services field. Many advanced variants (Specialist V roles) require a Master's degree.

• Professional Credential (QMHP-CS): Must meet the state criteria for a Qualified Mental Health Professional - Community Services (QMHP-CS). This requires explicit training and clinical competency tracking under Texas Administrative Code guidelines.

• Clinical Knowledge: Foundational knowledge of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), psychopharmacology basics, and trauma-informed care practices.

• Assessments & Systems: Proficiency in utilizing standard state screening metrics, such as being certified in the Adult Needs and Strengths Assessment (ANSA) tool.

• Mobility & Transit: Valid Texas Driver's License and active auto insurance to provide mobile, field-based services across various living environments. 

HCBS-AMH Nursing Services address the complex intersection of severe mental illness and physical health complications. While both roles focus on medication adherence, chronic condition monitoring, and psychiatric stabilization, their legal scopes of practice under the Texas Nursing Practice Act dictate different operational responsibilities. 

 

Job Descriptions & Core Responsibilities

 

Registered Nurse (RN)

The RN holds independent clinical authority and acts as the lead medical coordinator within the HCBS-AMH multidisciplinary team. Key duties include: 

• Comprehensive Assessments: Performing physical and psychiatric nursing assessments to identify medical triggers that complicate mental health recovery. 

• Recovery Plan Integration: Translating complex medical needs into the medical/nursing component of the individual’s Individual Recovery Plan (IRP). 

• Clinical Supervision & Delegation: Formally supervising and delegating specific nursing tasks to Licensed Vocational Nurses (LVNs) and unlicensed assistive personnel (UAPs). 

• Complex Care Management: Managing severe, unpredictable medical issues (e.g., advanced wound care, metabolic complications from antipsychotics). 

 

Licensed Vocational Nurse (LVN)

The LVN operates under a directed scope of practice, requiring direct or general supervision by the RN or an HHSC-approved clinician. Key duties include: 

• Focused Interventions: Delivering routine, structured nursing care to help stabilize ongoing psychiatric and chronic physical symptoms.

• Medication Administration & Monitoring: Administering prescribed oral or injectable psychiatric medications, while rigorously tracking adverse side effects or compliance issues.

• Health Data Tracking: Routinely collecting vital signs, metabolic metrics, and behavioral observation data to report changes in condition directly to the RN.

• Skills Training Support: Assisting the RN in teaching the participant basic healthcare habits, hygiene practices, and diabetic or dietary guidelines. 

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Mandatory Job Requirements & Qualifications

 

Requirements for Registered Nurses (RN)

• License: Active, unencumbered license to practice as a Registered Nurse in the State of Texas (or a valid Nurse Licensure Compact multi-state license).

• Education: Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) from an approved program.

• Experience: Typically a minimum of 12 months of clinical practice, with a strong preference for experience in community mental health or inpatient psychiatric care. 

Requirements for Licensed Vocational Nurses (LVN)

• License: Active, unencumbered license to practice as a Licensed Vocational Nurse in the State of Texas (or a Compact multi-state license).

• Education: High school diploma/GED plus graduation from a Texas Board of Nursing-approved Vocational Nursing certificate program.

• Experience: Minimum 12 months of experience as an LVN, preferably including experience volunteering or working directly with individuals diagnosed with serious mental illness (SMI). 

Shared Requirements for Both Roles

• Mandatory State Training: Prior to billing or service delivery, both roles must complete HHSC-required coursework, including Abuse, Neglect, and Exploitation (ANE), Advanced Skill Building (ASK), and specialized HCBS-AMH Nursing Services Best Practices training.

• Crisis Competency: Current Cardiopulmonary Resuscitation (CPR) or Basic Life Support (BLS) certification.

• Transit Capabilities: A valid Texas Driver's License and active auto insurance to facilitate mobile, field-based nursing care directly in participants' homes. 

The HCBS-AMH Community Psychiatric Supports and Treatment (CPST) Specialist provides evidence-based, goal-directed psychotherapeutic practices rather than purely functional or nursing interventions. They function as the primary clinical or therapeutic touchpoint in the community to stabilize psychiatric symptoms and resolve immediate systemic barriers. 

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Job Description & Core Responsibilities

A CPST Specialist delivers mobile, highly adaptive interventions designed to meet the participant’s specific clinical needs in their home or community environment. Key duties include: 

• Evidence-Based Therapy & Stabilization: Applying evidence-based and evidence-informed psychotherapeutic interventions to address severe emotional, behavioral, and mental health barriers. 

• Symptom & Crisis Management: Delivering face-to-face, proactive interventions to minimize psychiatric decompensation, de-escalate emotional distress, and prevent crisis-driven institutionalization. 

• Systemic Advocacy & Resource Linking: Assisting the individual in communicating effectively with the legal system, medical prescribers, landlords, or social services to ensure community integration remains intact. 

• Interdisciplinary Team Participation: Collaborating closely with the Recovery Manager (RM) and Provider Agency to directly inform the therapeutic goals mapped out within the Individual Recovery Plan (IRP). 

• Detailed Medicaid Progress Notes: Documenting precise clinical objectives and participant outcomes typically tracked in 15-minute billing units in strict compliance with Texas Medicaid guidelines. 

 

Mandatory Job Requirements & Qualifications

Because CPST involves psychotherapeutic interventions and clinical problem-solving, Texas requires candidates to hold distinct academic and state-regulated credentials: 

• Education: Minimum of a Bachelor's degree from an accredited college or university in psychology, social work, counseling, sociology, or a closely related human services field. Many advanced billing agencies prefer or require a Master's degree for specialized therapy tracks.

• Professional Credential (QMHP-CS): Must be fully certified as a Qualified Mental Health Professional - Community Services (QMHP-CS) in the state of Texas. This status requires formal verification of clinical competency and strict adherence to Texas Administrative Code rules.

• Clinical Training Profile: Demonstrated experience in therapeutic modalities such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) techniques, and trauma-informed de-escalation practices.

• Mandatory State Training: Must complete all state-mandated HHSC provider training, including Abuse, Neglect, and Exploitation (ANE) screening and advanced skill-building orientations.

• Mobility & Transit: A valid Texas Driver's License and active auto insurance are mandatory, as this is a mobile role requiring the clinician to meet participants across various residential and community settings. 

The HCBS-AMH Supervised Living Residential Staff (Caregiver) provide continuous care, assistance, and safety monitoring within a 24-hour community-based residential setting. This service is designed for individuals transitioning out of long-term state psychiatric hospitals or emergency settings who require a structured environment to maintain stability. Under the HCBS-AMH Provider Manual, Supervised Living is billed as a daily unit and must adhere strictly to federal HCBS home and community settings regulations. 

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Job Description & Core Responsibilities

Residential staff working in a Supervised Living environment function as the primary on-site support system for participants. Key duties include: 

• Activities of Daily Living (ADLs) Support: Providing direct personal assistance with essential hygiene tasks, including grooming, bathing, dressing, and eating. 

• Functional Living Tasks & Meal Planning: Assisting with and teaching foundational independent skills such as shopping, cleaning, budgeting, and preparing nutritionally sound meals.

• Therapeutic Reinforcement: Actively supporting and reinforcing the specialized rehabilitative, habilitative, or psychosocial strategies outlined in the participant's Individual Recovery Plan (IRP).

• 24-Hour Residential Supervision: Maintaining continuous presence in the residence to ensure home safety. Staff are either assigned to awake shift schedules or are present on-site during sleeping hours to respond immediately to emergency needs. 

• Mobility & Transit Assistance: Helping participants navigate public transit or directly transporting them to essential medical, psychiatric, and community integration appointments. 

• Crisis Management Coordination: Recognizing early warning signs of behavioral or psychiatric distress, utilizing trauma-informed de-escalation methods, and looping in the broader interdisciplinary recovery team when emergency intervention is necessary. 

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Mandatory Job Requirements & Qualifications

Per the Texas HHSC administrative guidelines, direct service providers of Supervised Living services must meet and verify the following criteria: 

• Age: Must be at least 18 years of age or older.

• Education: High school diploma, Certificate of High School Equivalency (GED), or documented proof of passing a written, competency-based assessment that verifies the applicant's experience and capacity to perform the required job tasks.

• Character References: Must submit at least three personal references from individuals who are not related to the applicant (within three degrees of consanguinity) that explicitly vouch for their ability to provide a safe and healthy residential environment.

• Mandatory State Training: Before rendering services, staff must complete all state-mandated training, which includes Abuse, Neglect, and Exploitation (ANE) screening and prevention, Person-Centered Planning, and basic behavioral health stabilization protocols.

• Background Check: Must clear rigorous criminal history background checks, including the Texas Department of Public Safety (DPS) registry and the Employee Misconduct Registry (EMR).

• Transit Capabilities: Typically requires a valid Texas Driver's License and active auto insurance if the specific shift duties include driving the facility's van or transporting participants.​

The HCBS-AMH Employment Specialist focuses on vocational restoration, economic security, and competitive community employment. While other specialists target stabilization or clinical therapy, the Employment Specialist works to reduce systemic and behavioral barriers to work for adults diagnosed with serious mental illness (SMI). Under the HCBS-AMH Provider Manual, this role encompasses two distinct billing areas: Employment Assistance (EA) to secure a job, and Supported Employment (SE) to sustain it.

 

Job Description & Core Responsibilities

An Employment Specialist uses evidence-based vocational models (such as Individual Placement and Support) to integrate participants into competitive workplaces. Key duties include: 

• Vocational Assessment & Profiling: Evaluating a participant's work history, strengths, preferences, and mental health barriers to develop a tailored career profile. 

• Job Development & Marketing: Actively partnering with local Texas business owners to uncover or customize employment opportunities that fit the participant's goals. 

• Employment Assistance (EA): Guiding participants through the job acquisition phase, including mock interviews, resume writing, and navigating the application process. 

• Supported Employment (SE) Coaching: Providing intensive, on-the-job training, teaching compensatory cognitive strategies, and monitoring interpersonal skills directly at the workplace. 

• Benefit Counseling Coordination: Assisting participants in understanding how earned income impacts their Texas Medicaid, SSI/SSDI, and housing subsidies to minimize financial anxiety. 

• Multi-Agency Alignment: Collaborating with the Texas Workforce Commission (TWC) Vocational Rehabilitation Services and the internal HCBS-AMH Recovery Manager (RM). 

 

 

Mandatory Job Requirements & Qualifications

The Texas HHSC framework allows provider agencies to qualify an Employment Specialist through multiple pathways combining education and disability service experience: 

• Pathway Option 1: Bachelor's degree in rehabilitation, business, marketing, or a related human services field, plus at least 6 months of experience providing services to people with disabilities.

• Pathway Option 2: Associate's degree in rehabilitation, business, marketing, or a related human services field, plus at least 1 year of experience providing services to people with disabilities.

• Pathway Option 3: High school diploma or GED, plus at least 2 years of experience providing services to people with disabilities.

• Mandatory State Training: Prior to billing, the specialist must complete HHSC-required provider training modules, including Abuse, Neglect, and Exploitation (ANE) prevention, Person-Centered Planning, and specific HCBS-AMH employment service guidelines.

• System Knowledge: Strong operational familiarity with Texas Medicaid waiver structures, TWC interfaces, and the Americans with Disabilities Act (ADA) accommodations.

• Mobility & Transit: A valid Texas Driver’s License and active auto insurance are strictly required, as the role necessitates regular travel to meet employers and participants across the community.