Heat the olive oil in a large skillet over medium-high heat. Add the ground beef and cook for 6 to 8 minutes, breaking it up as it browns. Season with salt and black pepper. Drain excess fat if needed.
Add the diced onion and cook for 3 to 4 minutes until softened. Stir in the garlic, Italian seasoning, and optional red pepper flakes.
Stir in the tomato paste and cook for 1 minute. Add the tomato sauce, diced tomatoes, Worcestershire sauce, garlic powder, and onion powder. Mix well.
Pour in the beef broth and bring to a gentle boil. Add the uncooked pasta shells, making sure they are mostly submerged. Reduce heat to medium and simmer for 12 to 14 minutes, stirring occasionally.
Lower the heat and stir in the heavy cream and cream cheese. Stir gently until smooth and creamy.
Gradually stir in the Pecorino Romano cheese until melted. Taste and adjust seasoning. Let rest 2–3 minutes off heat to thicken.
Spoon into bowls and garnish with fresh parsley and extra cheese. Serve and enjoy together.