In a medium saucepan over medium-low heat, warm the heavy cream until it's just below a simmer. Do not let it boil. Then add the Worcestershire sauce and optional horseradish.
Add the American cheese a few slices at a time, stirring until melted. Then add the provolone and stir until smooth. The sauce should be loose and pourable. Remove it from the heat.
Boil the tortellini in salted water until just al dente, about 1-2 minutes less than the package directions. Drain.
Heat the griddle or a large skillet to medium-high. Add the reserved ribeye fat and let it render. (If your ribeye did not have large chunks of fat, add about 1/2 tablespoon oil to the griddle or skillet.) Add the peppers, onions, and mushrooms. Season with salt and pepper, and cook until tender with a light char. Move them to a cooler zone, or remove them if you're using a skillet.
Add the sliced steak to the hot surface and cook quickly, until it's almost done to your liking. Do not overcook the steak - it will continue to cook a bit in the skillet with the other ingredients. Season the steak lightly with salt and pepper at the end, then combine with the vegetables.
Melt ¼ cup butter in a small pan. Stir in the panko until it's evenly coated, then set aside.
In a large bowl, fold together the al dente tortellini, steak, and vegetables with most of the cheese sauce. Reserve a little sauce for the top.
Butter a cast iron skillet or casserole dish. Add the tortellini mixture, drizzle with the reserved sauce, and sprinkle the buttered panko evenly over the top.
To bake on the grill: Set one side of the grill to off and the other to medium-low, aiming for about 350°F with the lid closed. Place the skillet over indirect heat. To bake indoors: Bake at 350°F.
Bake 15–20 minutes, rotating the skillet halfway through on the grill, until the sauce is bubbly and the panko is golden. Let it rest a few minutes before serving.