Gather all ingredients.
Set a large skillet over medium heat. Break up sausage into bite-sized chunks, removing any casings. Add to the pan and cook until browned on all sides, about 5 minutes. Remove sausage to a plate; set aside.
Let the skillet cool down for about 3 minutes; place back over medium heat and add butter, then garlic. Saute for 1 minute, then add black pepper, onion powder, Italian seasoning, and red pepper flakes; stir.
Pour in beef broth and heavy cream; stir to combine.
Add tortellini, cream cheese, and browned sausage to the skillet and stir to combine. Bring to a simmer, cover, reduce heat, and cook until tortellini is tender, about 5 minutes. Check for doneness, and simmer for 2 or 3 minutes more if needed.
Remove from heat and stir in Parmesan cheese. Serve in bowls with fresh basil on top.