In a large pot of salted boiling water, cook the rigatoni according to package directions until al dente. Reserve 1 cup of pasta water, then drain the rest and set aside.
In a large skillet over medium heat, add a drizzle of olive oil. Add the Italian sausage, breaking it apart with a wooden spoon. Cook until browned and cooked through, about 5-7 minutes.
Add the diced onion to the skillet and cook for 3-4 minutes until translucent. Stir in the minced garlic and cook for another minute until fragrant.
Pour in the crushed tomatoes and heavy cream. Stir to combine. Add the dried oregano, dried basil, and red pepper flakes, mixing well. Allow the sauce to simmer for about 5-10 minutes until it thickens slightly.
Add the drained rigatoni to the skillet with the sauce. Toss to coat, adding reserved pasta water as necessary to reach desired sauce consistency.
Taste and season with salt and pepper. Stir in the grated Parmesan cheese until well mixed.
Serve immediately garnished with fresh basil leaves and additional Parmesan if desired.
Notes
Adjust red pepper flakes for desired spice level.
Keyword creamy sauce, Italian sausage, pasta, rigatoni