An Alembic developer primarily works with Alembic, a database migration tool used with SQLAlchemy, a SQL toolkit and Object-Relational Mapping system for Python. They design, implement, and maintain database schemas, ensuring data integrity and optimizing performance. They create migration scripts to upgrade/downgrade a database schema to a new version, enabling smooth transitions between different versions of a database. They also help in version controlling of databases, which is critical in development environments. The developer needs to be skilled in Python, SQL databases, and understand the principles of data modeling and migration.