Bring water to a boil and cook pasta until al dente, about 8-10 minutes.

Drain and set aside.

Heat olive oil in a large skillet over medium heat.

Add the diced sausage and brown it until cooked through, about 5-7 minutes.

Add the diced onions and minced garlic. Cook until onions are tender and translucent, about 3-4 minutes. Stir in red pepper flakes if using.

Stir in the diced tomatoes and heavy whipping cream.

Bring the sauce to a simmer and stir in the Italian cheese blend until melted and creamy.

Add the cooked pasta to the skillet and toss gently to coat everything in the sauce. Garnish with fresh parsley flakes.