"This recipe was given to me by someone at work and I would love to give the creator credit, but do not know who it was! We travel in our motor home and did not want to lose the recipe. Everyone has loved this dish!"
Cook sausage in a large, deep skillet over medium heat until fat is rendered (about 8 minutes). Remove sausage from skillet with a slotted spoon, drain on paper towels and set aside. Discard any fat from the skillet in excess of 2 Tablespoons.
Add onion, garlic, crushed red pepper flakes and oil to the skillet and cook, stirring occasionally until soft, about 3 minutes. Stir in pumpkin puree, chicken stock and sage. Mix together and add salt. Bring to a boil, then lower the heat and simmer 5 minutes. Stir in cream and the cooked sausage. Simmer until the sauce comes together and is thickened slightly.
Add cook pasta and parsley to skillet and gently toss all the ingredients together to coat, place in casserole dish. Sprinkle top with Parmesan cheese and bake for 45 minutes until the topping is golden brown.