Start by removing the casings from the hot Italian sausage. In a dutch oven or soup pot, add olive oil and the sausage. Mash it up until it looks like ground beef. Cook over medium heat until browned.
Add the sliced onions, chopped garlic, and sliced mushrooms to the pot with the sausage. Season generously with salt and cracked black pepper. Sauté until the vegetables have softened and everything is nicely browned.
Sprinkle the flour over the sausage and vegetable mixture. Stir constantly for 2-3 minutes, allowing the flour to cook and create a roux.
Season the mixture with dried basil, oregano, mustard powder, red pepper flakes, hot sauce, and cayenne. Continue to sauté for an additional 2-3 minutes, ensuring the seasonings are evenly distributed.
Pour in the chicken broth and bring the mixture to a boil. Once boiling, reduce the heat to a simmer.
Add the heavy cream and the hunk of Pecorino Romano cheese. Let the soup simmer uncovered for 5-10 minutes, allowing the cheese to melt and the flavors to meld together.
Stir in the fresh baby spinach, and then add the cheese-stuffed tortellini, which should be cooked al dente. As you add the tortellini, allow some of the pasta water to drip into the soup, adding extra flavor.
To serve, garnish your creamy sausage and tortellini soup with grated Pecorino Romano cheese and fresh parsley. Enjoy your homemade, comforting bowl of soup!