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Heat a large skillet over medium-high heat. Add the diced smoked sausage and onion. Cook until the sausage is browned and the onion is softened.
Stir in the tomato paste and cook for 1 minute. Add the orzo and toast for another minute, stirring frequently.
Pour in the chicken broth and season with the Cajun seasoning, garlic powder, parsley, paprika, and black pepper. Stir well and bring to a boil.
Reduce the heat to a simmer and cook for 10–12 minutes, stirring occasionally, until the orzo is tender and most of the liquid has been absorbed.
Remove from the heat and stir in the heavy cream and Parmesan cheese until smooth and creamy.
Let the skillet rest for 5 minutes to thicken before serving.