Exchange Server 2016, Exchange Server 2019, Exchange Server Subscription Edition (SE)
Servers
Mailbox servers. Edge Transport servers aren't reachable over the Exchange PowerShell endpoint and aren't listed.
Endpoint
http://<server>/PowerShell, with Kerberos allowed on the PowerShell virtual directory (the default)
Rights
Organization Management, or a role group with the Exchange Server Certificates role. The health check also reads virtual directories, connectors and Get-AuthConfig, which View-Only Organization Management covers.
HTTP validation: port 80 open from the internet to Exchange for every name on the certificate, and admin rights on each server's Default Web Site folder (local, or through the c$ admin share).
DNS validation: access to add TXT records in your public DNS.
Automatic renewal: a service account with the Exchange rights above and local administrator on the machine running the task. The app stays in the folder it was registered from.