Heat oil in a dutch oven or large stock pot, over medium heat. Add garlic, cubed squash, salt, pepper, smoked paprika and nutmeg. Stir to coat.
Cover and cook for 6-8 minutes, or until squash is slightly softened. Add broth, bring to a simmer, and cook for 8-10 minutes until squash is completely tender.
Use an immersion blender to blend until smooth. (Alternately you can use a blender, blending in batches and then returning to the pot.)
Slowly stir in the cheese, until melted, then stir in coconut millk.
Add tortellini, cover and cook for 9 minutes, until tender.
Meanwhile, cook the sausage in a medium skillet, breaking up with a spatula until browned and cooked through. Drain well and add to the soup. Stir to combine.
Ladle into soup bowls and serve topped with chopped green onions, if desired.