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Bring a large pot of salted water to a boil over high. Add pasta; cook until al dente, about 11 minutes. Drain and set aside.
Place sausage in a cold 12-inch skillet. Cook over medium-high, stirring often, until browned, 5 to 8 minutes. Transfer sausage to a plate.
Reduce heat to medium; add butter to drippings in skillet, stirring until melted, about 1 minute. Add chopped red bell pepper and Vidalia onion. Cook, stirring often, until onion is tender, about 3 minutes. Add flour; cook, stirring constantly, until lightly toasted, about 1 minute. Increase heat to medium-high; whisk in milk, and cook, whisking constantly, until mixture thickens, about 5 minutes. Stir in Cajun seasoning, salt, and reserved sausage. Add pepper Jack, stirring until just melted, about 1 minute.
Remove from heat, and stir in cooked pasta. Garnish with sliced scallions and hot sauce.